Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virol. Nov 12, 2016; 5(4): 170-182
Published online Nov 12, 2016. doi: 10.5501/wjv.v5.i4.170
Geographic integration of hepatitis C virus: A global threat
Mohamed A Daw, Abdallah A El-Bouzedi, Mohamed O Ahmed, Aghnyia A Dau, Mohamed M Agnan, Aisha M Drah
Mohamed A Daw, Department of Medical Microbiology and Immunology, Faculty of Medicine, 82668 Tripoli, Libya
Mohamed A Daw, Professor of Clinical Microbiology and Microbial Epidemiology, Acting Physician Internal Medicine, Scientific Coordinator of Libyan National Surveillance Studies of Viral Hepatitis and HIV, CC 8266 Tripoli, Libya
Abdallah A El-Bouzedi, Department of Laboratory Medicine, Faculty of Biotechnology, 82668 Tripoli, Libya
Mohamed O Ahmed, Department of Microbiology and Parasitology, Faculty of Veterinary Medicine, 82668 Tripoli, Libya
Aghnyia A Dau, Department of Surgery, Tripoli Medical Centre, Faculty of Medicine, 82668 Tripoli, Libya
Mohamed M Agnan, Aisha M Drah, Department of Pharmacology, Faculty of Medical Technology, Alga-bal Algarbi University and Faculty of Medicine, 82668 Tripoli, Libya
Author contributions: Daw MA designed the study, extracted the data, drafted and finalized the manuscript; El-Bouzedi AA, Ahmed MO, Dau AA, Agnan MM and Drah AM analyzed the data and contributed to the drafting of the data; all the authors read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: We confirm that the data is available from the corresponding author who will provide a permanent, citable and open access home for the dataset.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Mohamed A Daw, MD, FTCDI, Department of Medical Microbiology and Immunology, Faculty of Medicine, Alfurnaj Road, 82668 Tripoli, Libya.
Telephone: +218-91-2144972 Fax: +218-21-3612236
Received: March 31, 2016
Peer-review started: April 1, 2016
First decision: May 17, 2016
Revised: June 5, 2016
Accepted: July 11, 2016
Article in press: July 13, 2016
Published online: November 12, 2016

To assess hepatitis C virus (HCV) geographic integration, evaluate the spatial and temporal evolution of HCV worldwide and propose how to diminish its burden.


A literature search of published articles was performed using PubMed, MEDLINE and other related databases up to December 2015. A critical data assessment and analysis regarding the epidemiological integration of HCV was carried out using the meta-analysis method.


The data indicated that HCV has been integrated immensely over time and through various geographical regions worldwide. The history of HCV goes back to 1535 but between 1935 and 1965 it exhibited a rapid, exponential spread. This integration is clearly seen in the geo-epidemiology and phylogeography of HCV. HCV integration can be mirrored either as intra-continental or trans-continental. Migration, drug trafficking and HCV co-infection, together with other potential risk factors, have acted as a vehicle for this integration. Evidence shows that the geographic integration of HCV has been important in the global and regional distribution of HCV.


HCV geographic integration is clearly evident and this should be reflected in the prevention and treatment of this ongoing pandemic.

Keywords: Geo-epidemiology, Integration, Hepatitis C virus genotypes, Geography, Phylogeography

Core tip: Geographic integration of hepatitis C virus (HCV) is a newly described epidemiological phenomenon that is illustrated for the first time in this review article. The global burden of HCV infection has surpassed expectations and HCV genotypes are no longer restricted to certain countries or regions. All countries and their citizens are at a higher risk of HCV infection. HCV integration can be either intra-continental or trans-continental. Globalization, immigration and drug trafficking, in addition to the traditional HCV transmission factors, have acted as vectors for the geographical integration of HCV. International efforts and new strategies that go beyond borders should be combined to tackle this global threat.