Epidemiology of HCV Infection among Thalassemia Patients in Eastern Mediterranean Countries: a Quantitative Review of Literature

Background: Hepatitis C infection (HCV) is the major co-morbidity in thalassemia patients; however, literature lacks data from many EMRO counties. There is also enormous heterogeneity in the available study results in this region, and distribution of HCV infection among these patients living in this region is still unknown. This study provides a comprehensive and reliable tabulation of available data on the epidemiological characteristics and risk factors for hepatitis C virus (HCV) infection in thalassemia patients in eastern mediterranean countries. Methods: A systematic review was carried out based on the computerized literature database. 95% confidence intervals of infection rates were calculated using the approximate normal distribution model. Pooled Odds ratios and 95% CI were calculated by fixed or random effects models. The heterogeneity was assessed by either Q or c2 statistics. Publication bias was evaluated by either Harbor’s modified or Egger’s test. Results: We identified 40 studies that fulfilled our inclusion criteria involving 8554 thalassemia subjects. Pooled HCV seroprevalence was 18% (95% CI 14-21), 45% (95% CI 43-48), 63% (95% CI 56-69) and 69% (95% CI 58- 80) in Iran, Pakistan, Saudi Arabia and Egypt, respectively. Among Iranian thalassemia patients, splenectomy OR=4.1 (95% CI 1.5-11.2), high transfusion OR=3.5 (95% CI 1.8-7), high age OR=6.1(95% CI 1.2-31.2) and first transfusion before 1996 OR=7.6 (95% CI 4.7 -12.3) were major risk factors of HCV infection. Conclusions: There are no data from many EMRO countries. Among major EMRO countries, Iran has the least seroprevalence of HCV infection among thalassemia patients. This underscores more advanced blood safety in this country compared with other countries with comparable population in this region.