Early initiation of antiretroviral treatment: Challenges in the Middle East and North Africa

Table 1 Evidence-based prevalence rates of human immunodeficiency virus, hepatitis B and C co-infections in 13 countries of the Middle East and North Africa region

Country - city names(yr)	Target population(n)1	HIV prevalence	Methodology	HCV2(Isolated or co-infection prevalence)	HBV2(Isolated or co-infection prevalence)
Afghanistan - three cities (2009)[36,56]	FSWs (n = 520)	0.19%	Cross-sectional	Isolated: 1.92%	Isolated: 6.54% (range: 3% to 17.5%)
					Isolated: 7.1%
	PWIDs	7.1% (1% to 18.4%)	Cross-sectional	Isolated: 40.3%
				Co-infection: 94.9%
Bahrain - Bahrain (2002-2006)[57]	HCV infected patients (n = 183)	0.5%	Retrospective cohort	HCV-HBV co-infection: 3.3%	-
Egypt - Cairo (2010)[58]	Blood donors-family members (n = 15017)	0.01%	Cross-sectional	Isolated: 4.3%	Isolated: 1.7%
Iraq - Karbala (2009)[59]	Healthcare workers (n = 124)	0	Cross-sectional	0	0
Iran - Tehran (2007)[60]	PWIDs (n = 899)	10.7%	Cross-sectional	Isolated: 34.5% Co-infection: 80.6%	Isolated: 50.7% Co-infection: 7.8%
Jordan (2009)[61]	Blood donors (n = 8190)	0	Cross-sectional	Isolated: 0.9%	Isolated: 1.4%
Lebanon - Beirut (2008)[62]	Inmates (n = 580)	0.17%	Cross-sectional	Isolated: 3.43%	Isolated: 2.4%
Libya - Tripoli (2013)[27]	PWIDs (n = 328)	87%	Respondent-driven sampling	Co-infection: 83%	Co-infection: 4%
Morocco - Casablanca (2006-2010)[63]	HIV infected patients of a referral clinic (n = 504)	All patients were infected.	Cohort	5.4%	Co-infection: 5.2%
Pakistan - Lahore (2011)[64]	Inmates (n = 4915)	2.01%	Cross-sectional	Co-infection: 73.74%	0.01% (HBV/HCV Co-infections: 77.78%)
Saudi Arabia (2009)[65]	PWIDs (n = 344)	Not checked	Cross-sectional	Isolated: 38% (HBV-HCV: 3.5%)	Isolated: 12% (HBV DNA)
(2012)[66]	Rehab center inmates-drug users				Isolated: 4%
	(n = 115)	4%	Cross-sectional	-
Tunisia (2007)[67]	HIV infected patients	Not applicable	Cross-sectional	Co-infection: 39.7%	-
	(n = 362)			(For PWIDs: 87.4%)
Yemen - Hodeidah (2010)[68]	Blood donors (n = 1483)	0.14%	Cross-sectional	Isolated: 0.79%	Isolated: 2.35%

¹Sample size;

²Lab evaluations: Anti-HIV antibody (enzymatic immunoassay or western blot); Anti-HCV antibody; HBs antigen (enzymatic immunoassay). HCV: Hepatitis C virus; HBV: Hepatitis B virus; FSWs: Female sex workers; PWIDs: People who inject drugs.