Occult hepatitis C virus infection in the Middle East and Eastern Mediterranean countries: A systematic review and meta-analysis

Table 2 Subgroup-specific pooled estimates of occult hepatitis C virus infection prevalence across the Middle Eastern and Eastern Mediterranean countries

Prevalence by	Number of studies	Sample sizes	OCI prevalence across studies		Pooled OCI prevalence		Heterogeneity
			Range (%)	Median	Mean (%)	95%CI	Cochran’s Q	I-squared (%)
Studied population
Blood donors	1	138	-	-	5.80	2.93-11.16	-	-
Hemodialysis patients	13	1427	0-27.27	4.84	9.06	5.83-13.80	64.0a	81.2
Healthy sexual partners of patients with chronic hepatitis C	1	50	-	-	4.00	1.00-14.63	-	-
Patients with chronic hepatitis C who achieved SVR	4	1604	0-12.86	7.62	6.70	3.08-13.99	25.4a	88.2
Patients with cryptogenic liver disease	4	212	8.89-44.44	21.11	21.70	11.26-37.72	22.6a	86.7
Patients with autoimmune hepatitis	1	35	-	-	1.39	0.09-18.67	-	-
Patients with lymphoproliferative disorders	1	104	-	-	1.92	0.48-7.36	-	-
Hemophilia patients	1	450	-	-	10.22	7.74-13.38	-	-
Thalassemia patients	2	287	3.31-5.66	4.49	4.32	2.47-7.46	0.9	0.00
HIV positive individuals	2	225	9.79-12.20	10.99	10.72	7.29-15.50	0.3	0.00
HIV positive injecting drug users	1	77	-	-	18.18	11.07-28.39	-	-
Injecting drug users	1	115	-	-	9.57	5.38-16.45	-	-
Mixed population1	5	476	10.78-36	13.79	18.15	10.20-30.20	18.2b	78.1
Countries
Egypt	17	2585	3.33-44.44	11.33	12.34	8.32-17.92	186.2a	91.4
Iran	17	2343	0-32.08	9.57	8.48	5.51-12.84	86.5a	81.5
Pakistan	1	104	-	-	0.48	0.03-7.15	-	-
Saudi Arabia	1	84	-	-	14.29	8.30-23.49	-	-
Turkey	1	84	-	-	3.57	1.16-10.49	-	-
Temporal duration2
Before 2015	18	1227	0-44.44	9.52	9.58	6.26-14.40	88.5a	80.8
2015 and thereafter	19	3973	3.03-36	10.22	10.33	7.21-14.61	192.07a	90.6
Method of HCV RNA detection
RT-nested PCR	22	2833	0-44.44	9.97	11.75	8.52-15.99	159.3a	86.8
Real time RT-PCR	12	2174	0-23.08	7.75	7.88	4.96-12.30	58.4a	81.2
RT-PCR	2	130	145.71-173.33	159.52	7.75	2.34-22.75	3.3	69.5
Strand-specific PCR	1	63	-	-	12.70	6.48-23.39	-	-
Patients’ HCV serostatus
Seronegative	25	2774	0-44.44	5.80	9.32	6.76-12.73	164.0a	85.4
Seropositive	4	1604	6.20-66.50	37.62	6.64	2.94-14.30	25.4a	88.2
Seronegative/ Seropositive	7	756	27.27-109.09	73.53	13.58	8.01-22.11	17.8b	66.3
Undetermined	1	66	-	-	27.27	17.91-39.19	-	-
Sample size
Less than 100	23	1440	0-44.44	12.20	12.43	8.87-17.15	102.4a	78.5
100 and above	14	3760	0-23.56	7.69	7.43	4.86-11.19	153.0a	91.5
Patients’ sex
Female	11	602	0-35.29	8.62	9.92	5.39-17.55	32.4a	69.2
Male	11	1785	0-30.56	9.09	10.17	5.85-17.10	70.8a	85.9
All studies	37	5200	0-44.44	10.14	10.04	7.66-13.05	284.1a	87.3

^aP < 0.001.

^bP < 0.01.

¹Four studies investigated occult hepatitis C virus infection among healthy volunteers along with hemodialysis patients, patients with chronic hepatitis C, or patients with hematologic and lymphoproliferative disorders. Also one study investigated both the patients with chronic hepatitis C and patients with cryptogenic liver disease.

²Based on the last year reported for the data collection. If the collection date was not clear, publication year was considered instead. CI: Confidence interval; Min: Minimum; Max: Maximum; PCR: Polymerase chain reaction; RT-PCR: Reverse transcription polymerase chain reaction; OCI: Occult hepatitis C virus infection.