Does HCV Prevalence in Blood Donors Reflects the Incidence in General Population? A Study for Global Impact

Pakistan is endemic for hepatitis C Virus (HCV) infection with around 11 million infections [1,2]. The knowledge about the prevalence of HCV in general population is very limited and it is difficult to screen the whole population of the country [3]. Over all socio-economic status of Pakistan is low, with very low budget on health surveillance system [4]. Furthermore, in past few years the allocated health budget was spent on other viral infections like Polio and Dengue due to media hypes [5]. As Pakistan has huge burden of HCV and it is necessary to keep track of surveillance of this silent killer. HCV is chronic disease and can leads to liver fibrosis and cirrhosis. The management of chronic HCV infection is very difficult and can have a substantial effect on the economic status of the individuals, society and ultimately the country. The current standard of care antiviral therapies includes interferon based and interferon free direct acting antivirals (DAAs) [6]. Interferon based regimes have side effects where as DAAs are very costly to manage for treatment of all infected individuals [7,8]. Keeping the current scenario in mind, the monitoring of HCV prevalence across the country is the need of the hour. Pakistan is a populated country with about 200 million inhabitants and it is difficult to screen all individuals due to poor socio economic situation of the country. The problem was highlighted recently [3], that it is very difficult to screen the whole population in a resource constrain country like Pakistan. But it is also very important to identify viral infection hot spot for proper management of the disease and carry out awareness campaigns. We tried to find another way of proper monitoring the HCV prevalence in Pakistan. The analysis of previously published data is carried out to find whether the prevalence of HCV in healthy blood donors reflects the seroprevalence of the virus in the general population and could be used as monitoring system. All published reports from Pakistan regarding the HCV prevalence in general healthy population or health blood donors were retrieved from different sources from 2010 to date. The data analysis showed that there are 17 and 14 studies on HCV prevalence in general population and healthy blood donors respectively from 2010-2016 (Table 1) [9-34]. Most of the studies on general populations are with small number of individuals while the results of studies on blood donors provide a larger sample groups. The total individuals screened from general population were 96,407 in previous studies while screening of 464,722 individuals were reported through blood donations. The analysis of data showed that in 2010-2013 HCV prevalence among general population ranged from 4.3-6% while a greater variability was observed in 2014 (11%). This higher prevalence and inconsistency in different years is might be due to smaller number of study subjects. On the other hand HCV prevalence in blood donor’s population is consistent during study period (Figure 1). In general population HCV prevalence ranged from 4.32-11.14% while in blood donors the prevalence range is quite narrow i.e. 1.05-3.24%, most probably due to larger number of study participants. The total population of Pakistan is about 200 million and it is estimated that around 11 million are infected with HCV (1-3) which is about 5-6% of total population. On the basis of current available information (Figure 1) it seems data from blood donors showed more reliable figures (2-3% infection rate) as compared with general population (6-11% infection rate). The high risk groups for HCV infection significantly contributed in total number of infections in Pakistan. There are many other high risk groups for HCV infections like liver disease patients, pregnant women, multi transfused individuals, intravenous drug users, health care workers, prisoners, homosexual men. To further strengthen the point, the previous data from high risk groups were analyzed, which clearly suggested that these high risk groups (with infection rate up to 66%) contributed to a larger proportion in total number of HCV infections.