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

Table 4 Subgroup-specific pooled estimates of occult hepatitis C virus infection prevalence among patients with chronic liver diseases across the Middle Eastern and Eastern Mediterranean countries

Variables	Number of studies	Sample sizes	OCI prevalence across studies		Pooled OCI prevalence (%)		Heterogeneity
			Range (%)	Median	Mean (%)	95%CI	Cochran’s Q	I-squared (%)
Countries
Egypt	5	1689	3.91-44.44	11.33	16.08	5.81-37.35	152.4a	97.4
Iran	5	272	0-32.08	10.14	11.46	3.64-30.73	16.6b	76.0
Pakistan	1	104	-	-	0.48	00.03-7.15	-	-
Temporal duration1
Before 2015	8	523	0-44.44	10.46	11.83	4.84-26.14	46.0a	84.8
2015 and thereafter	3	1542	3.91-34.82	11.33	12.28	3.23-36.99	111.1a	98.2
Method of HCV RNA detection
RT-nested PCR	6	359	0-44.44	21.11	21.38	11.73-35.75	30.5a	83.6
Real time RT-PCR	4	1636	0-11.33	7.35	6.29	2.73-13.84	23.9a	87.4
RT-PCR	1	70	-	-	12.86	6.83-22.90	-	-
Patients’ subpopulation
Post-HCV non-viremic cases2	5	1716	0-34.82	11.33	9.14	3.02-24.53	116.8a	96.6
Cryptogenic liver diseases3	4	212	8.89-44.44	21.11	20.81	6.87-48.35	22.6a	86.7
Chronic HCV infection and Cryptogenic liver diseases2,3	1	102	-	-	10.78	6.07-18.43	-	-
Autoimmune hepatitis	1	35	-	-	1.39	0.09-18.67	-	-
Patients’ HCV serostatus
Seronegative	5	247	0-44.44	10.14	16.13	5.41-39.28	27.7a	85.6
Seropositive	5	1716	0-34.82	11.33	9.11	2.97-24.69	116.8a	96.6
Seronegative/seropositive	1	102	-	-	10.78	6.07-18.43	-	-
Sample size
Less than 100	6	317	0-44.44	11.50	15.63	6.08-34.67	32.2a	84.5
100 and above	5	1748	0-34.82	10.78	8.88	3.04-23.26	116.0a	96.5
All studies	11	2065	0-44.44	10.78	12.04	5.87-23.10	179.3a	94.4

^aP < 0.001.

^bP < 0.01.

¹Based on the last year reported for the data collection. If the collection date was not clear, publication year was considered instead.

²Including those patients who achieved sustained virologic response after treatment with anti-virals.

³Including unexplained persistently abnormal liver enzymes and cryptogenic cirrhosis. CI: Confidence interval; Min: Minimum, Max: Maximum; PCR: Polymerase chain reaction; RT-PCR: Reverse transcription polymerase chain reaction; OCI: Occult hepatitis C virus infection.