Potential for human immunodeficiency virus parenteral transmission in the Middle East and North Africa: An analysis using hepatitis C virus as a proxy biomarker

Table 1 Hepatitis C virus prevalence among general population groups in the Middle East and North Africa

Country	Population	Seroprevalence (%)	Ref.
Afghanistan	Blood donors	0.3-1.9	[123,124]
	Pregnant women	0.31	[125]
Algeria	Blood donors	0.18	[126]
	Pregnant women	0.19-0.63	[126,127]
Bahrain	Blood donors	0.3	[128]
Djibouti	Blood donors	0.3	[129]
Egypt	Army recruits	22.1	[130]
	Blood donors	2.7-26.6	[103,131-140]
	Children	2.1-12.1	[84,94,103,130,141,142]
	Family of HCV positive patients	0-14	[143]
	Fire brigade personnel	39	[103]
	General population	10-41.9	[91,144,145]
	Healthy populations	5-46.7	[95,146-150]
	National survey	14.7	[62]
	Pregnant women	4.3-19	[151-154]
	Rural populations	2.7-60	[90,155-158]
	Tourism workers	14.3	[159]
	Visa applicants	31.5	[95]
Iran	Blood donors	0.1-2.1	[114,160-166]
	Children	0-0.6	[167,168]
	Family of HCV positive patients	1.3	[169]
	General population	0.1-3.1	[170]
	Healthy populations	12.3	[171]
Iraq	Pregnant women	3.2	[172]
Kuwait	Blood donors	0.8-5.4	[173]
	Outpatients	1	[174]
Lebanon	Blood donors	0.4-0.7	[175-178]
	General population	0.7	[179]
Libya	Blood donors	0.9-6.6	[180-183]
	Healthy populations	1.6-7.9	[180,182]
	National survey	1.2	[184]
Morocco	Blood donors	0.2-1.1	[185-188]
	Pregnant women	0.5-1	[185,189]
Oman	Blood donors	0.4-1.5	[190-193]
Pakistan	Blood donors	0.5-16	[64,76,194-201]
	Children	1.7-2.1	[75,76]
	Family of HCV positive patients	0.4-20.5	[202-204]
	General population	4.7-5.4	[64,76]
	Healthy adults	3	[76]
	Rural populations	4.6-33.7	[66,67,121,205,206]
	Vaccinated population with smallpox	21	[67]
	Women	6.7	[205]
Palestine	General population	2.2	[144]
Qatar	Blood donors	0.4-2.8	[207,208]
	General population	0.9	[209]
Saudi Arabia	Blood donors	0.4-4.6	[72,210-218]
	Children	0.1-1.8	[70-72]
	General population	1.7-3.6	[219,220]
	Outpatients	2.1-22.5	[221]
	Pregnant women	0.1-4.6	[72,222,223]
	Subjects tested for HCV	5.1	[210]
Somalia	Blood donors	0.6	[224]
	Blood donors and hospitalized populations	2.4	[224]
	Children	0-1.5	[73,74]
	Healthy populations	1-6.5	[73,225]
Sudan	Outpatients	3	[226]
	Pregnant women	0.6	[227]
Syria	Blood donors	0.95	[228]
Tunisia	Blood donors	0.6-1.1	[229,230]
	General population	0.2-1.7	[231-233]
Turkey	Blood donors	0.2-0.4	[234-239]
	Controls	1.3	[240]
	Engaged couples	0.1	[241]
	Family of HCV positive patients	2	[242]
	General population	0.6-2.3	[241,243,244]
	Obstetrics and gynecology patients	0.9	[245]
	Outpatients	2.2	[246]
	Rural populations	1	[247]
	Soldiers	0.5-0.6	[237]
UAE	Blood donors	0.5-1.10	[248,249]
	College students	0-0.4	[250,251]
Yemen	Blood donors	1.1	[252]
	Healthy populations	2.1-4.2	[253,254]

Results shown are not of an exhaustive and systematic literature review. HCV: Hepatitis C virus; UAE: United Arab Emirates.

Table 2 Hepatitis C virus prevalence among different populations at higher risk of hepatitis C virus infection in the Middle East and North Africa

Country	Population	Seroprevalence (%)	Ref.
Afghanistan	People who inject drugs	36.6	[255]
Algeria	Multi-transfused patients	30	[86]
Bahrain	Hemodialysis patients	7.4-9.24	[128,256]
	Multi-transfused patients	40	[257]
Egypt	Children with hepatosplenomegaly	16.4	[130]
	Chronic liver disease patients	46.2-73.5	[130,258]
	Hepatocellular carcinoma patients	78.5-84	[147,259]
	Healthcare workers	1.4-7.7	[137,260]
	Hemodialysis patients	46.2-100	[130,137,261-263]
	People who inject drugs	63	[145,264]
	Jaundice patients	27.3	[265]
	Kidney transplant patients	23.3	[266]
	Multi-transfused patients	11.1-81.6	[84,103,130,137,267-271]
	Prisoners	31.4	[103]
	Sexually transmitted infections patients	5.3	[272]
Iran	Female sex workers	2.7	[273]
	Hepatitis B virus patients	12.3	[274]
	Hemodialysis patients	2.9-55.9	[160,275-279]
	HIV positive patients	11.5	[280]
	Multi-transfused patients	5.1-71.3	[44,113,160,161,168,277,281-293]
	Injecting and non-injecting drug users	7.4-80	[104,105,164,278,294-299]
	Prisoners	30-78	[104,105,297,300,301]
Iraq	HIV positive patients	66	[302]
	Multi-transfused patients	67.3	[303]
Jordan	Multi-transfused patients	40.5	[304]
Kuwait	Hemodialysis patients	27-40	[305-307]
	Multi-transfused patients	33	[308]
Lebanon	Healthcare workers	2.6	[309]
	HIV positive patients	25	[310]
Libya	Diabetics	24.4	[311]
	Healthcare workers	2-6.8	[180,182,312]
	Hemodialysis patients	20.5-42.5	[180,313]
	Multi-transfused patients	10.8	[180]
Morocco	Barbers	1.1-5	[99,314]
	Hemodialysis patients	10.1-76	[88,185,315,316]
	Multi-transfused patients	2.3-42.4	[185,316-318]
Oman	Hemodialysis patients	26.5	[190]
	People who inject drugs	11-53	[319]
	Kidney transplant patients	13.4	[190]
	Medical students	0	[190]
Pakistan	HCC patients	33	[320]
	Healthcare workers	5.5-31	[76,321,322]
	Hemodialysis patients	68	[65,323]
	Hospital attendees	3.1	[324]
	Injecting and non-injecting drug users	22-91	[325-328]
	Multi-transfused patients	13.2-60.0	[329-331]
	Patients receiving frequent injections	44	[332]
	Type 2 diabetes patients	36	[333]
Qatar	Hemodialysis patients	44.6	[334]
Saudi Arabia	Cancer patients	11	[70]
	Chronic liver disease patients	63.6	[335]
	Healthcare workers	2.2	[336]
	Hemodialysis patients	6.9-84.6	[72,210,219,256,337-343]
	Injecting and non-injecting drug users	10.5-74.6	[72,220]
	Multi-transfused patients	4.6-78.6	[222,344-347]
	Non-Hodgkins lymphoma patients	21	[348]
	Schistosomiasis patients	17.9	[336]
Somalia	Chronic liver disease patients	40.3	[225]
	Female sex workers, sexually transmitted infection patients, soldiers, tuberculosis patients	1.8	[349]
	Hospitalized patients	2.2	[73]
Sudan	Hemodialysis patients	19-34	[350,351]
	Hospital attendees	0.4	[352]
	High schistosomiasis region	2.2	[353]
Syria	Female sex workers	1.96	[228]
	Healthcare workers	0-6	[354]
	Hemodialysis patients	54.4	[355]
	People who inject drugs	60.5	[228]
Tunisia	Diabetics	1.3	[356]
	Healthcare workers	1	[357]
	Hemodialysis patients	20-46.5	[358-361]
	HIV positive patients	39.7	[362]
	Multi-transfused patients	42-50.5	[363-365]
Turkey	Barbers	2.8	[100]
	Cancer patients	2.8-5.8	[366-368]
	Diabetic patients	3.2-20.8	[240,369]
	Female sex workers	0.8	[370]
	Healthcare workers	0.3-1.5	[234,371]
	Hemodialysis patients	0-51.2	[369,371-374]
	Chronic kidney disease patients	7	[375]
	Multi-transfused patients	4-24.4	[371,376]
United Arab Emirates	Hemodialysis patients	24.4	[377]
	Multi-transfused patients	18.8	[378]
Yemen	Chronic liver disease patients	21.5-37.1	[253,254]
	Healthcare workers	0.5-3.5	[252,379]

Results shown are not of an exhaustive and systematic literature review. HIV: Human immunodeficiency virus; HCC: Hepatocellular carcinoma.

Table 3 Human immunodeficiency virus prevalence among high risk human immunodeficiency virus parenteral-transmission population groups in the Middle East and North Africa (other than people who inject drugs)

Country	Population	Seroprevalence (%)	Ref.
Bahrain	Children with hereditary hemolytic anemia	1.6	[257]
Egypt	Blood or blood products recipients	4.8	[380]
	Thalassemia patients	0	[381]
	Children with hemophilia	0	[382]
Iran	Thalassemia patients	0	[44,113,160,168,277,284,288-291,383]
	Hemophilia patients	0-2.3	[161,277,281-284,287]
Jordan	Multi-transfused patients	0	[304]
Lebanon	Multi-transfused patients	0	[384]
Morocco	Hemodialysis patients	0	[316]
Pakistan	Multi-transfused patients	0.98	[385]
	Hemodialysis patients	0.98	[277]
Qatar	Children with thalassemia	38.5	[386]
Saudi Arabia	Multi-transfused, thalassemia and sickle cell disease patients	1.3	[387]
	Children undergoing cancer therapy	0	[70]
	Hemodialysis patients	0	[388]
Tunisia	Hemodialysis patients	0	[359]
	Hemophiliacs	8.6	[365]

Results shown are not of an exhaustive and systematic literature review.