Epidemiology of hepatitis C virus in the Arabian Gulf countries: Systematic review and meta-analysis of prevalence

• Hepatitis C virus (HCV) prevalence is around 1% in the Arabian Gulf region.
• The higher prevalence in expatriate populations reflects the prevalence in the countries of origin.
• There is evidence of ongoing HCV transmission through exposures linked to the medical setting.
• Injecting drug use does not appear to be the dominant contributor to HCV incidence.

SummaryObjectiveThe aims of this study were to perform a systematic review and synthesize epidemiological data on hepatitis C virus (HCV) in the Arabian Gulf countries, and to assess the country-specific prevalence among nationals and expatriate populations.MethodsA systematic review of HCV antibody prevalence and incidence in the Arabian Gulf countries was conducted, based on the items outlined in the PRISMA statement. Meta-analyses were performed incorporating inverse variance weighting and using a random-effects model to pool summary estimates of HCV prevalence among general population groups, for nationals and the entire resident population.ResultsA total of 557 prevalence measures and one incidence measure were identified for the Arabian Gulf countries. HCV prevalence among nationals was 0.24% (95% confidence interval (CI) 0.02–0.63) in the United Arab Emirates (UAE), 0.44% (95% CI 0.29–0.62) in Kuwait, 0.51% (95% CI 0.43–0.59) in Qatar, and 1.65% (95% CI 1.40–1.91) in Saudi Arabia. No data were available for Bahrain or Oman. Among the entire resident populations, HCV prevalence was 0.30% (95% CI 0.23–0.38) in Bahrain, 0.41% (95% CI 0.35–0.46) in Oman, 1.06% (95% CI 0.51–1.81) in Qatar, 1.45% (95% CI 0.75–2.34) in Kuwait, 1.63% (95% CI 1.42–1.84) in Saudi Arabia, and 1.64% (95% CI 0.96–2.49) in UAE. A higher prevalence was observed among expatriate populations such as Egyptians. Among the high-risk populations, HCV prevalence was as high as 78.6% in the multi-transfused and 74.6% in people who inject drugs.ConclusionsNational-level HCV prevalence in the Arabian Gulf region is comparable to global levels. A higher prevalence is found in specific expatriate populations, reflecting the prevalence in their countries of origin. Most exposures appear to occur in high-risk groups and these are often linked to medical care.