• Genotypes
• HCV
• Molecular evolution
• Pakistan
• Spatial distribution

• Hepatitis C virus
• amino acid substitution
• core protein
• epitopic vaccine
• phylogenetics
• protein modelling

• Hepatitis C virus
• genotype
• hepatocellular carcinoma
• quantification
• real-time PCR

• Adult
• Age Distribution
• Carcinoma, Hepatocellular/epidemiology
• Carcinoma, Hepatocellular/etiology
• Enzyme-Linked Immunosorbent Assay
• Female
• Genotype
• Hepacivirus/genetics
• Hepacivirus/isolation & purification
• Hepatitis C/diagnosis
• Hepatitis C/epidemiology
• Humans
• Liver Diseases/epidemiology
• Liver Diseases/etiology
• Liver Neoplasms/epidemiology
• Liver Neoplasms/etiology
• Male
• Middle Aged
• Pakistan/epidemiology
• Prevalence
• Real-Time Polymerase Chain Reaction
• Risk Factors
• Sex Distribution
• Young Adult

• Blood donors
• Madagascar
• sickle cell disease

• Adolescent
• Adult
• Anemia, Sickle Cell/blood
• Anemia, Sickle Cell/epidemiology
• Blood Banks/organization & administration
• Blood Banks/statistics & numerical data
• Blood Donors/statistics & numerical data
• Blood Transfusion
• Female
• Humans
• Madagascar/epidemiology
• Male
• Middle Aged
• Prevalence
• Regional Medical Programs/organization & administration
• Regional Medical Programs/statistics & numerical data
• Sickle Cell Trait/blood
• Sickle Cell Trait/epidemiology
• Young Adult

• HCV
• Pakistan
• epidemiology
• genotype
• public health

Introduction

Hepatitis C has emerged as a big challenge for Pakistan. Health care providers are at increased risk of being infected due to tremendous exposure.

Aim

The purpose of this study was to find the prevalence of hepatitis C, its risk factors especially its occupational risk factors and preventive measures practiced by health care providers of Tehsil Head Quarter Hospital, Hasilpur, Pakistan.

Materials and methods

Blood samples were collected, and rapid chromatography strips were used for diagnostic purpose. A questionnaire was used for data collection. After analyzing the data, results were summarized.

Results

The prevalence of Hepatitis was 5.17%. Those who used gloves were 67.24%. A history of needle stick injury was present in 47.41%, and 49.13% knew about the spread of Hepatitis C Virus (HCV). Just 18.96% knew about the treatment plan, and 19.83% had attended a workshop on preventive measures of infectious diseases in healthcare settings.

Conclusion

The frequency of HCV among health care providers is high. Awareness programs and training workshops should be mandatory to increase knowledge about hepatitis C prevention. It will decrease the incidence of hepatitis C infection among health care workers.

• frequency of hepatitis c
• healthcare workers
• hepatitis c
• risk factors

Hepatitis C virus (HCV) is a leading cause of chronic liver disease and frequently progresses towards liver cirrhosis and Hepatocellular Carcinoma (HCC). This study aimed to determine the prevalence of HCV genotypes and their association with possible transmission risks in the general population of Malakand Division.

Sum of 570 serum samples were collected during March 2011 to January 2012 from suspected patients visited to different hospitals of Malakand. The suspected sera were tested using qualitative PCR and were then subjected to molecular genotype specific assay. Quantitative PCR was also performed for determination of pre-treatment viral load in confirmed positive patients.

Out of 570 serum samples 316 sera were seen positive while 254 sera were found negative using qualitative PCR. The positive samples were then subjected to genotyping assay out of 316, type-specific PCR fragments were seen in 271 sera while 45 samples were found untypable genotypes. Genotype 3a was seen as a predominant genotype (63.3%) with a standard error of ±2.7%. Cramer’s V statistic and Liklihood-Ratio statistical procedures are used to measure the strength and to test the association, respectively, between the dependent variable, genotype, and explanatory variables (e.g. gender, risk, age and area/districts). The dependent variable, genotype, is observed statistically significant association with variable risk factors. This implies that the genotype is highly dependent on how the patient was infected. In contrast, the other covariates, for example, gender, age, and district (area) no statistical significant association are observed. The association between gender-age indicates that the mean age of female was older by 10.5 ± 2.3 years with 95% confidence level using t-statistic.

It was concluded from the present study that the predominant genotype was 3a in the infected population of Malakand. This study also highlights the high prevalence rate of untypable genotypes which an important issue of health care setup in Malakand and create complications in therapy of infected patients. Major mode of HCV transmission is multiple uses and re-uses of needles/injections.

ISRCTN ISRCTN73824458. Registered: 28 September 2014

• Distribution patterns
• Genotypes potential
• HCV
• Malakand
• Risks factors

• ELISA
• HIV p24 antigen
• Nigeria
• blood tranfusion/donor
• youth

• HCV
• Pakistan
• blood donors
• epidemiology
• general population
• high-risk population
• interferon-free antivirals
• treatment guidelines

• Genotype
• Hepatitis C Virus
• Meta-Analysis
• Molecular Epidemiology
• Prevalence
• Systematic Review

The purpose of this study was to explore molecular epidemiology of HCV genotype 3a in Peshawar based on sequencing and phylogenetic analysis of Core region of HCV genome.

Chronically infected Hepatitis C virus infected patients enrolled under the Prime Minister Hepatitis C control program at three Tertiary care units of Peshawar [Khyber Teaching Hospital Peshawar, Lady Reading Hospital Peshawar, Hayat Abad Medical Complex Peshawar] were included in this cross sectional observational study. Qualitative detection of HCV and HCV genotyping was carried out by a modified reverse transcription-polymerase chain reaction (RT-PCR) and type specific genotyping assay. The Core gene of HCV genotype 3a was amplified, cloned and sequenced. The sequences obtained were used for phylogenetic analysis using MEGA 6 software.

Among the 422 (82.75 %) PCR positive samples, 192 (45.5 %) were identified as having HCV genotype 3a infection. HCV Core gene sequencing was carried out randomly for the characterization of HCV 3a. Nucleotide sequence analysis of the obtained viral genomic sequences based on partial HCV 3a Core gene sequences with reference sequences from different countries showed that our sequences clustered with some local and regional sequences with high bootstrap values.

HCV 3a is highly prevalent in Peshawar, Pakistan and its phylogenetics based on Core gene sequences indicate the prevalence of different lineages of HCV 3a in Peshawar which may have consequences for disease management strategies causing more economic pressure on the impoverished population due to possible antiviral resistance.

• HCV 3a
• Hepatitis C
• Pakistan
• Peshawar KP

Hepatitis C virus (HCV) is endemic in Pakistan and its burden is expected to increase in coming decades owing mainly to widespread use of unsafe medical procedures. The prevalence of HCV in Pakistan has previously been reviewed. However, the literature search conducted here revealed that at least 86 relevant studies have been produced since the publication of these systematic reviews. A revised updated analysis was therefore needed in order to integrate the fresh data. A systematic review of data published between 2010 and 2015 showed that HCV seroprevalence among the general adult Pakistani population is 6.8%, while active HCV infection was found in approximately 6% of the population. Studies included in this review have also shown extremely high HCV prevalence in rural and underdeveloped peri-urban areas (up to 25%), highlighting the need for an increased focus on this previously neglected socioeconomic stratum of the population. While a 2.45% seroprevalence among blood donors demands immediate measures to curtail the risk of transfusion transmitted HCV, a very high prevalence in patients attending hospitals with various non-liver disease related complaints (up to 30%) suggests a rise in the incidence of nosocomial HCV spread. HCV genotype 3a continues to be the most prevalent subtype infecting people in Pakistan (61.3%). However, recent years have witnessed an increase in the frequency of subtype 2a in certain geographical sub-regions within Pakistan. In Khyber Pakhtunkhwa and Sindh provinces, 2a was the second most prevalent genotype (17.3% and 11.3% respectively). While the changing frequency distribution of various genotypes demands an increased emphasis on research for novel therapeutic regimens, evidence of high nosocomial transmission calls for immediate measures aimed at ensuring safe medical practices.

• Hepatitis C
• Pakistan
• Hepatitis C virus
• Liver cancer
• Hepatitis C virus genotypes
• Epidemiology

• Genotype
• Hepacivirus/genetics
• Hepacivirus/immunology
• Hepatitis C/diagnosis
• Hepatitis C/epidemiology
• Hepatitis C/virology
• Humans
• Incidence
• Molecular Diagnostic Techniques
• Molecular Epidemiology
• Pakistan/epidemiology
• Phenotype
• Predictive Value of Tests
• Prevalence
• Prognosis
• Risk Factors
• Serologic Tests

Sickle cell trait (SCT) or Hemoglobin S (HbS) trait which is due to inheritance of an abnormal hemoglobin (Hb) gene from one parent and a normal gene from the other has been known to be common among people of African descent. Individuals with SCT may find themselves in the blood donor population without knowing their ‘carrier’ status and this may have severe consequences on their health as well as that of a recipient, particularly if they happen to be a sickle cell disease patient. The aim of the study was to determine the prevalence of HbS trait among blood donors.

This cross-sectional study employed convenience sampling method to recruit subjects. A total of 150 prospective and healthy blood donors comprising 138 males and 12 females were involved in the study. Two (2) ml of venous blood was collected from each donor into K₃EDTA tubes and analyzed using the sodium metabisulphite slide test and cellulose acetate Hb electrophoresis at alkaline pH (8.6) for Hb genotypes. Statistical Package for Social Sciences version 20.0 (SPSS 20.0) and Chi square were used to analyse the data obtained. Out of the 150 blood donors, 133 (88.7 %) tested negative for sickling (131 were genotype AA and 2 were AC) and 17 (11.3 %) tested positive for sickling, all of whom were genotype AS.

The results of the study showed the existence of SCT among the blood donor population sampled. Taking blood from such people can harm their health as well as that of the recipient if they happen to be sickle cell disease (SCD) patients. It is therefore recommended that blood donors as well as donated blood units should be screened for SCT to avoid causing any harm to both the donor and recipient.

The aim of this study was to estimate the prevalence of viral hepatitis C (HCV) infection among healthcare workers (HCWs) compared to the general population. A systematic search for the years 1989–2014 was conducted in the Medline, Embase and Cochrane databases. Studies on hepatitis C in HCWs were included if they incorporated either a control group or reference data for the general population. The study quality was classified as high, moderate or low. Pooled effect estimates were calculated to determine the odds of occupational infection. Heterogeneity between studies was analysed using the χ² test (p<0.10) and quantified using the I² test. 57 studies met our criteria for inclusion and 44 were included in the meta-analysis. Analysis of high and moderate quality studies showed a significantly increased OR for HCV infection in HCWs relative to control populations, with a value of 1.6 (95% CI 1.03 to 2.42). Stratification by study region gave an OR of 2.1 in low prevalence countries; while stratification by occupational groups gave an increased prevalence for medical (OR 2.2) and for laboratory staff (OR 2.2). The OR for professionals at high risk of blood contact was 2.7. The pooled analysis indicates that the prevalence of infection is significantly higher in HCWs than in the general population. The highest prevalence was observed among medical and laboratory staff. Prospective studies that focus on HCW-specific activity and personal risk factors for HCV infection are needed.

• Healthcare workers < Materials
• exposures and occupational groups

Pakistan is a low income country with more than 10 million hepatitis C virus (HCV) infections and the burden is on continuous raise. Accurate viral genotyping is very critical for proper treatment of the infected individuals as the sustained virological response of the standard antiviral interferon therapy is genotype dependent. We observed at our diagnostic center that 15.6% of HCV patient’s samples were not genotype-able by using Ohno et al method. The genotyped samples showed that 3a (68.3%) is the major prevalent genotype in Pakistan followed by 2a (10.3%), 3b (2.6%), 1b (1.5%), 2b (1.2%) and 1a (0.5%). Presence of large number of untypable HCV variants in the current study highlights an important issue of health care setup in Pakistan. Untypable HCV cases create difficulties in treatment of these patients. The problem of routine diagnostics setup of Pakistan should be addressed on priority basis to facilitate the medical professionals in patient’s treatment and to help in achieving the maximum sustained virological response.

• Hepatitis C virus
• Genotypes
• Diagnostics
• Untypable variants
• Antiviral interferon therapy
• Pakistan

• Antiviral Agents/therapeutic use
• Developing Countries
• Genotype
• Hepacivirus/genetics
• Hepatitis C/diagnosis
• Hepatitis C/drug therapy
• Hepatitis C/epidemiology
• Hepatitis C/virology
• Humans
• Molecular Diagnostic Techniques
• Pakistan/epidemiology
• Predictive Value of Tests
• Prevalence
• Prognosis
• Reproducibility of Results

• TTIs screening
• post-donation
• pre-donation

• Blood Banks/economics
• Blood Donors
• Blood Safety/economics
• Blood Safety/methods
• Blood-Borne Pathogens
• Cost-Benefit Analysis
• Developing Countries
• HIV Infections/prevention & control
• HIV Infections/transmission
• Hepatitis B/prevention & control
• Hepatitis B/transmission
• Hepatitis C/prevention & control
• Hepatitis C/transmission
• Humans
• Mass Screening/economics
• Mass Screening/methods
• Nigeria
• Retrospective Studies
• Transfusion Reaction
• Blood Banking/methods

With improved HCV therapy, challenges regarding HCV diagnosis, such as seronegative window period, false positive readings, and differentiation between recent, chronic, and resolved infections, are of increasing importance. To address these challenges an innovative device—SMARTube HIV & HCV—was used. Blood samples were tested for anti-HCV antibodies before and after incubation in the SMARTube, which promotes the in vitro stimulation of in vivo HCV primed lymphocytes, thus enhancing levels of anti-HCV antibodies. Comparing antibody levels, in concordant samples before and after SMARTube, yielded the Stimulation Index (SI). Among 5888 fresh blood samples, from various populations and regions worldwide, 641 were seropositive using plasma, while SMARTube processing (yielding enriched plasma, termed SMARTplasma) enabled diagnosis of 10 additional carriers in high-risk cohorts, that is, earlier detection. Using SMARTplasma eliminated all false positive results, using the current assays. In addition we show that SI calculation may serve as an important tool for differentiating between those who recently seroconverted, carriers of long-term infection, and those who have cleared the virus. SMARTube and the SI could lead to better, more informative diagnosis of HCV infections and play an important role in changing the way we treat both the infected individuals and the epidemic as a whole.

• Anti HCV antibody
• health care workers
• occupational exposure

Transfusion transmitted infections create significant burden on health care system. Donor selection is of paramount importance because infected individuals serve as an asymptomatic reservoir and a potential source of transmission.

A retrospective study was carried out in healthy blood donors in the Lady Reading Hospital Peshawar, Pakistan over a period of three and a half years i.e., from January 2008 to June 2011, to determine the prevalence of HBV, HCV, HIV and syphilis in order to provide information for relevant polices.

Out of 1,27,828 sample of blood donors, recorded mean prevalence for HBs Ag, anti-HCV, anti-HIV and syphilis was 2.68%, 2.46%, 0.06% and 0.43%, respectively, with an increasing trend in frequencies of transfusion transmitted infections (TTIs).

This study reflects that blood transfusion is one of the leading risk factor of spread of the TTIs, which showed the need and importance of the mandatory screening of these infectious markers in blood donations.

Hepatitis C Virus (HCV) genotype and viral load are two significant predictive variables knowledge of which might persuade treatment decisions. The objective of the present study was to identify the distribution of different HCV genotypes circulating in the study area and to estimate viral load in chronically HCV infected patients. Out of total 305 HCV positive patients, 177 (58%) were males and 128 (42%) were females. Frequency breakup of the HCV positive patients was 169, 69, 38 and 29 from Abbottabad, Mansehra, Haripur and Battagram districts respectively. Out of the total 305 tested serum samples, 255 (83.06%) were successfully genotyped whereas 50 (16.4%) samples were found with unclassified genotypes. Among typable genotypes, 1a accounted for 21 (6.8%) 1b for 14 (4.6%), 2a for 4 (1.31%) 3a for 166 (54.42%) and genotype 3b for (8.19%). Twenty five (8.19%) patients were infected with mixed HCV genotypes. Viral load distribution was classified into three categories based on its viral load levels such as low (< 60, 0000 IU/mL), intermediate (60,0000-80,0000 IU/mL) and high (> 80,0000 IU/mL). The baseline HCV RNA Viral load in HCV genotype 3 infected patients was 50 (26.17%), 46 (24.08%) and 95 (49.73%) for low, intermediate and high categories respectively. For genotypes other than 3, these values for low, intermediate and high viral load categories were 50 (43.85), 35 (30.70) and 29 (25.43) respectively. Pre-treatment viral load in patients with untypable genotype was 19 (38.00%), 5 (20.00%) and 11 (44.00%) for low, intermediate and high viral load categories. Viral load distribution was also categorized sex wise; for males it was 58 (32.76%), 26 (14.68%) and 93 (52.54%) whereas for females it was 40 (31.25%), 34 (26.56%) and 54 (42.18%) for low, intermediate and high viral load respectively. In conclusion HCV genotype 3a is the most prevalent genotype circulating in Hazara Division like other parts of pakistan. Pre-treatment viral load is significantly high (p 0.014) in patients infected with HCV genotype 3 as compared to other genotypes.

High prevalence of Hepatitis C virus (HCV) has been reported among the dialysis patients throughout the world. No serious efforts were taken to investigate HCV in patients undergoing hemodialysis (HD) treatment who are at great increased risk to HCV. HCV genotypes are important in the study of epidemiology, pathogenesis and reaction to antiviral therapy. This study was performed to investigate the prevalence of active HCV infection, HCV genotypes and to assess risk factors associated with HCV genotype infection in HD patients of Khyber Pakhtunkhwa as well as comparing this prevalence data with past studies in Pakistan.

Polymerase chain reaction was performed for HCV RNA detection and genotyping in 384 HD patients. The data obtained was compared with available past studies from Pakistan.

Anti HCV antibodies were observed in 112 (29.2%), of whom 90 (80.4%) were HCV RNA positive. In rest of the anti HCV negative patients, HCV RNA was detected in 16 (5.9%) patients. The dominant HCV genotypes in HCV infected HD patients were found to be 3a (n = 36), 3b (n = 20), 1a (n = 16), 2a (n = 10), 2b (n = 2), 1b (n = 4), 4a (n = 2), untypeable (n = 10) and mixed (n = 12) genotype.

This study suggesting that i) the prevalence of HCV does not differentiate between past and present infection and continued to be elevated ii) HD patients may be a risk for HCV due to the involvement of multiple routes of infections especially poor blood screening of transfused blood and low standard of dialysis procedures in Pakistan and iii) need to apply infection control practice.

• hcv
• genotypes
• prevalence
• pakistan

• Humans
• Antiviral Agents/therapeutic use
• Databases, Bibliographic
• Genotype
• Hepacivirus/classification
• Hepacivirus/genetics
• Hepatitis C/drug therapy
• Hepatitis C/epidemiology
• Hepatitis C/genetics
• Hepatitis C/virology
• Molecular Typing
• Pakistan/epidemiology
• Phylogeny
• Phylogeography
• Prevalence
• RNA, Viral/genetics