Abstract
BACKGROUND: Despite high hepatitis C virus (HCV) prevalence in the Former Soviet Union (FSU), data on genotype distribution and resistance-associated substitutions (RAS) remain fragmented. This study aims to map the breadth of molecular epidemiological evidence on HCV genotypes and resistance in FSU. METHOD: We performed a scoping review with a genotype meta-analysis of 24 cross-sectional studies published in PubMed, Web of Science, and Google Scholar from 1990 to 2025. The systematic review was registered with PROSPERO (CRD420251140060). RESULTS: The pooled prevalence of the major HCV genotypes (G1, G2, and G3) was 98.02% (95% CI: 96.71-98.94%), with G1 having the highest prevalence (59%), followed by G3 (27%). G1 was highest in the Mixed Region (73.5%) and lowest in the South Caucasus (30.6%), G2 was highest in the Southern Caucasus (16.8%), and G3 was highest in Eastern Europe (34.5%). Crucially, baseline RAS data were severely limited, with only four small studies (n = 329) from Russia and Georgia reporting clinically significant RAS (NS5A-A30K, Y93H). CONCLUSION: This study confirms G1 and G3 as the predominant circulating HCV genotypes in the FSU and highlights the near absence of data on RAS. Achieving HCV elimination in this region depends on both strengthening the care cascade and implementing robust virological surveillance systems.