Hepatitis C virus prevalence and genotype distribution in Pakistan: Comprehensive review of recent data

Table 1 Hepatitis C virus seroprevalence among healthy adult population

S. #	Year	Place	Method	Sample size			Seroprevalence (%)			Ref.
				Male	Female	Total	Male	Female	Total
1	2009	Lahore	ELISA9	-	-	2000	-	-	6.5	[38]
2	2009	Larkana	ICT1	353	97	450	7.37	4.12	6.66	[46]
3	2010	Swat	ICT2	290	300	590	6.2	11.3	8.81	[45]
4	2010	Mansehra	ICT2	-	-	400	-	-	7.0	[36]
5	2010	Thatta/Nausheroferoz	ICT3	-	-	303	-	-	25.1	[29]
6	2010	Karachi(peri-Urban)	EIA4	649	1348	1997	19	26	23.83	[28]
7	2010	Karachi	ICT9	351	153	504	2.8	5.23	3.17	[34]
8	2010		ELISA9							[41]
		Multan		625	-	625	9.6	-	9.6
		Lahore		1892	-	1892	9.4	-	9.4
		Faisalabad		2736	-	2736	8.8	-	8.8
		Gujranwala		16522	-	16522	7.3	-	7.3
		Gujrat		9770	-	9770	6.8	-	6.8
		Sargodha		1620	-	1620	6.7	-	6.7
		Rawalpindi		445	-	445	6.7	-	6.7
		Sialkot		24707	-	24707	6.2	-	6.2
		Bahawalpur		363	-	363	5.0	-	5.0
9	2010	Islamabad	ICT9	-	252	252	-	24.6	24.6	[40]
10	2010	Mansehra	ICT9	394	254	648	11.8	9.4	10.34	[44]
11	2010	National Survey	ICT3	24444	22599	47043	4.9	4.8	4.87	[21]
12	2011	Gujranwala	EIA5	1770	732	2502	2.6	1.68	2.32	[43]
13	2011	Karachi	CLIA6	-	-	32049	-	-	9.75	[35]
14	2012	Kech	EIA7	709	1291	2000	7.62	4.34	5.5	[26]
15	2012	Punjab	EIA7	14027	14027	-	3.13	-	3.13	[39]
16	2014	Mardan	ICT8	757	662	1419	13.6	9.52	11.7	[37]
17	2014	Peshawar	CMIA4	543	439	982	15.4	9.7	12.93	[42]

¹Nobis Labordiagnostica, Cluj-Napoca, Romania;

²Acon Laboratories, CA, United States;

³Bionike Inc. CA, United States;

⁴Abbott Diagnostics, IL, United States;

⁵DSI, srl. Saronno VA, Italy;

⁶Roche Diagnostics, CA, United States;

⁷DiaSorin International Inc., Saluggia, Italy;

⁸Accurate Diagnostic Labs, NJ, United States;

⁹Manufacturer not mentioned in cited reference. ELISA: Enzyme linked immunosorbent assay; CLIA: Chemiluminescence immunoassay; ICT: Immunochromatographic test; EIA: Enzyme immunoassay; CMIA: Chemiluminescent microparticle immunoassay.

Table 2 Seroprevalence of hepatitis C virus infection in blood donors

S. #	Year	Place	Method	Sample size	Seroprevalence (%)	Ref.
1	2009	Mirpurkhas	ELISA7	804	15.05	[25]
2	2010	Multan	ELISA1	10000	4.90	[88]
3	2010	Peshawar	ELISA7	32042	1.57	[92]
4	2011	KPK/FATA	ELISA2	7148	1.89	[89]
5	2011	KPK/FATA	ELISA2	62251	2.60	[91]
6	2011	Karachi	-8	5717	1.90	[86]
7	2012	Karachi	ELISA3	5517	2.00	[83]
8	2012	Peshawar	ELISA2	127828	2.46	[84]
9	2012	Sargodha	ELISA3	100	12.00	[85]
10	2013	Karachi	MEIA/CLIA4	108598	2.61	[87]
11	2013	Quetta	ELISA2	356	20.8	[27]
12	2013	Lahore	ELISA5	245	15.00	[82]
13	2014	Karachi	CLIA6	42830	1.65	[90]

¹Labkit Chemelex, Barcelona, Spain;

²Biokit;

³General Biologicals Corporation, Taiwan;

⁴Abbott Diagnostics,

⁵DiaSorin;

⁶Ortho Clinical Diagnostics, NJ, United States;

⁷Manufacturer not mentioned in cited reference;

⁸Method not mentioned in cited reference. KPK: Khyber Pakhtunkhwa; FATA: Federally Administered Tribal Areas; ELISA: Enzyme linked immunosorbent assay; MEIA: Microparticle immunoassay; CLIA: Chemiluminescence immunoassay.

Table 3 Hepatitis C virus in patients with liver disease

S. #	Year	Place	Method	Sample size	Seroprevalence (%)				Ref.
Hepatocellular carcinoma
1	2009	Punjab/KPK	ELISA1	145	76.5				[97]
2	2009	Pakistan	EIA2	82	79.2				[98]
3	2010	Karachi	-5	40	50				[94]
4	2013	Pakistan	ELISA4	645	48.5				[95]
5	2014	Hyderabad	ELISA4	188	66				[96]
Liver disease					AH	CH/CLD	Carrier	Cirrhosis
6	2009	Swat	ELISA4	110	-	-	-	63.6	[99]
7	2009	Pakistan	EIA2	107	-	62.6	-	24.3	[98]
8	2010	Karachi	-5	5153	7	72.9	51.7	59.4	[94]
Hepatic encephalopathy
9	2009	Hyderabad	-5	87	66.67				[100]
Suspected for viral hepatitis
10	2014	Islamabad	ELISA3	845	24.8				[101]

¹DRG Instruments, Germany;

²Abbott Diagnostics;

³Biokit;

⁴Manufacturer not mentioned in cited reference;

⁵Method not mentioned in cited reference. AH: Acute hepatitis; CH: Chronic hepatitis; CLD: Chronic liver disease; ELISA: Enzyme linked immunosorbent assay; EIA: Enzyme immunoassay; KPK: Khyber Pakhtunkhwa.

Table 4 Hepatitis C virus serofrequency in high risk population groups

S. #	Year	Place	Method	Sample size	Seroprevalence (%)	Ref.
Pregnant women
1	2009	Hazara	ELISA1	500	8.6	[104]
2	2009	Swat	ICT6	5607	2.6	[105]
3	2009	Karachi	EIA2	5902	1.8	[106]
4	2010	Multan	ICT6	500	7.0	[107]
5	2011	Karachi	ELISA3	18000	5.79	[102]
6	2013	Hyderabad	ELISA2	3078	4.7	[103]
Multi-transfused population (including pediatric population)
7	2009	Islamabad	ELISA6	103	36.0	[108]
8	2010	Lahore	Questionnaire	408	1.5	[110]
9	2011	KPK	ICT4	40	15.0	[111]
10	2011	Karachi	ELISA3	173	51.4	[86]
11	2012	Karachi	ELISA5	160	13.0	[83]
12	2014	Rawalpindi	ELISA6	95	49.5	[109]
Intravenous drug users
13	2011	KPK	ICT4	42	14.28	[111]
14	2011	KPK	ICT4			[113]
		Peshawar		100	35.0
		Kohat		60	25.0
		Mardan		40	32.5

¹Ortho Clinical Diagnostics;

²Abbott Diagnostics;

³DiaSorin;

⁴Acon Laboratories, CA, United States;

⁵General Biologicals Corporation;

⁶Manufacturer not mentioned in cited reference. KPK: Khyber Pakhtunkhwa; ELISA: Enzyme linked immunosorbent assay; EIA: Enzyme immunoassay; ICT: Immunochromatographic test.

Table 5 Hepatitis C virus serofrequency in miscellaneous high risk population groups

S. #	Year	Place	Method	Sample Size	Seroprevalence (%)	Ref.
Health care workers
1	2008	Abbottabad	ELISA7	125	5.6	[116]
2	2011	Peshawar	ICT1	824	4.1	[115]
Prisoners
3	2010	Sindh	ELISA2	7539	12.8	[117]
4	2010	Karachi	ELISA3	357	15.2	[118]
Dialysis patients
5	2011	KPK	ICT4	25	28.0	[111]
6	2011	Peshawar	ELISA1	384	29.2	[119]
Homosexual community
7	2010	Sindh	ELISA5	396	23.5	[120]
Vertical transmission
8	2011	Karachi	ELISA6	129	3.9	[102]

¹Acurate Diagnostics;

²Medical Biological Services, Italy;

³Abbott Diagnostics;

⁴Acon Laboratories;

⁵Biokit;

⁶DiaSorin;

⁷Manufacturer not mentioned in cited reference. KPK: Khyber Pakhtunkhwa; ELISA: Enzyme linked immunosorbent assay; ICT: Immunochromatographic test.

Table 6 Hepatitis C virus seropositivity among patients other than those with liver disease

S. #	Year	Place	Method	Sample size	Seroprevalence (%)	Ref.
Urological patients
1	2010	Lahore	ELISA4	558	13.4	[130]
Major gynecological surgery
2	2009	Karachi	EIA1	548	16.2	[106]
Surgery (eye/elective/major)
3	2010	Sukkur	ICT5	913	13.8	[126]
4	2011	KPK	ICT2	25	8.0	[111]
5	2013	Kharian	ELISA5	554	6.4	[122]
Dental surgery
6	2011	KPK	ICT2	35	14.28	[111]
Type II diabetes
7	2010	Multan	ELISA3	3000	30.2	[88]
Cataract patients
8	2012	Karachi	ELISA5	377	11.4	[127]
Dermatological disorders
9	2012	Karachi/Rawalpindi	ELISA5	355	9.01	[128]
Tuberculosis patients
10	2013	Rahim Yar Khan	ELISA4	110	9.1	[121]
Sexually transmitted infection patients
11	2014	Faisalabad	ELISA1	39780	21.99	[124]
Seeking hospital care (Misc diseases/disease not defined)
12	2010	Bannu	ELISA5	25944	3.3	[125]
13	2011	Karachi	ELISA1	2965	12.8	[123]
14	2011	Kotli (AJK)	ELISA5	9564	6.38	[129]

¹Abbott Diagnostics;

²Acon Laboratories;

³Labkit;

⁴Bio-tech Company Limited, United States;

⁵Manufacturer not mentioned in cited reference. KPK: Khyber Pakhtunkhwa; ELISA: Enzyme linked immunosorbent assay; EIA: Enzyme immunoassay; ICT: Immunochromatographic test.

Table 7 Prevalence of active hepatitis C virus infection in Pakistan

S. #	Year	Place	Sample size			Active HCV infection (%)			Ref.
			Male	Female	Total	Male	Female	Total
General population
1	2010	Swat	290	300	590	2.8	5.7	4.2	[45]
2	2010	Mansehra	300	100	400	4.0	2.0	3.5	[36]
3	2012	Rawalpindi	147	156	303	17.7	16.7	17.2	[135]
		Islamabad	75	125	200	5.3	3.2	4.0
4	2013	Lahore	1914	2332	4246	5.3	4.7	4.9	[134]
5	2014	Mardan	757	662	1419	11.5	5.1	8.5	[37]
Intravenous drug users
6	2011	KPK			42			14.3	[111]
7	2011	KPK			200			24.0	[113]
Dialysis patients
8	2011	KPK			25			28.0	[111]
9	2011	KPK			384			27.6	[119]
Blood donors
10	2011	KPK/FATA	-	-	7148	-	-	1.6	[89]
Health care workers
11	2011	KPK			824			2.8	[115]
Multi transfused population
12	2011	KPK			40			15.0	[111]
Patients undergoing major surgery
13	2011	KPK			25			8.0	[111]
Dental surgery patients
14	2011	KPK			35			14.3	[111]
Pregnant women
15	2011	Karachi			18000			-1	[102]

¹Out of 18000 subjects studied, 1043 women tested positive for anti- hepatitis C virus (HCV) during screening; only 640 out of these 1043 agreed to undergo nucleic acid testing of which 510 tested positive for HCV-RNA. KPK: Khyber Pakhtunkhwa; FATA: Federally Administered Tribal Areas.

Table 8 Frequency distribution of hepatitis C virus genotypes in Pakistan

Frequency (%) of hepatitis C virus genotypes
1			2			3			4			5		6		Mixed	Untypable	Ref.
1a	1b	U	2a	2b	U	3a	3b	U	4a	4b	U	5a	U	6a	U
3.5	0.8	-	1	-	-	88.1	3	-	-	-	-	-	-	-	-	3.6	-	[142]
6.1	6	-	15.1	6.1	-	42.3	12.1	-	-	-	-	-	-	-	-	-	12.1	[45]
0.72	0.72					80.26	6									6.73	27.88	[151]
5.4			8.1			34.1	7									7.6	37.8	[154]
1.5	2.5		39	1		31	8										17	[17]
7.14			35.71			28.6					14.29						14.29	[113]
12.1	1.2	-	1.2	0.4	0.31	64.5	6.4	0.0011	6.7	0.6	-	0.5	-	0.4	-	3.2	2.4	[156]
14.3	3.6	-	8.9	1.8	-	32.1	17.8		1.8							10.7	8.9	[119]
6.8	4.6		1.3			54.4	8.2									8.2	16.4	[152]
5.6	-	-	-	-	-	90.3	0.6	-	-	-	0.6	-	-	-	-	2.8	-	[141]
2.6	0.8	-	0.3	0.2	-	82.6	0.2	-	-	-	-	0.1	-	-	-	2.4	10.8	[150]
12.5	8.9		9.8	1.8		42.9	22.3										1.8	[149]
7.4	5.8	-	13.2	6.6	-	26.4	16.5	-	-	-	2.5	-	-	-	-	4.1	17.4	[37]
10	3.6	-	-	-	-	56.4	15	-	-	-	1.4	-	-	-	-	7.1	6.4	[143]
1.3	0.7	-	-	-	-	82.1	13.9	-	-	-	-	-	-	-	-	2	-	[146]
1	-	-	12	-	-	38.2	21	-	-	-	-	-	-	-	-	7.3	21	[148]
8.8	3	-	6.5	1	-	45.5	16	-	0.8	-	-	-	-	-	-	16	2.2	[145]
5.3	5.1	11	24.9	6.1	-	39.4	6.3	-	2.4			2.4		2		-	5.7	[18]
2.9	1.5	-	-	-	1.2	70.3	5.5	-	-	-	-	-	0.9	-	-	2.6	15.1	[157]
3.3	0.8	0.21	2.1	0.2	0.021	61	8.9	0.241	-	-	0.5	0.1		0.1		4.7	17.8	[153]
23.6	-	-	-	-	-	55.9	3.2	-	12.5	1.2	-	-	-	-	-	1.2	2.5	[155]
4.3	-	-	-	-	-	73.9	13	-	-	-	-	-	-	-	-	4.3	4.3	[115]
0.9	0.9	-	7.4	0.9	-	66.1	2.6	-	-	-	-	-	-	-	-	2.2	18.8	[144]
-	-	-	1.1	2.2	-	86.8	2.2	-	-	-	-	-	-	-	-	-	7.7	[149]
7.1	-	-	-	-	-	50	10.7	-	-	-	-	-	-	-	-	-	32.1	[140]
0.5	1.5	-	10.3	1.2	-	68.3	2.6	-	-	-	-	-	-	-	-	-	15.6	[158]

¹Subtype C. U: Undefined subtype.