Hedayati-Moghaddam Mohammad Reza, Soltanian Hossein, Ahmadi-Ghezeldasht Sanaz
Blood Borne Infections Research Center, Academic Center for Education, Culture and Research (ACECR), Razavi Khorasan Branch, Mashhad 91779-49367, Iran.
World J Hepatol. 2021 Feb 27;13(2):242-260. doi: 10.4254/wjh.v13.i2.242.
The presence of hepatitis C virus (HCV) RNA in liver tissue or peripheral blood mononuclear cells with no identified virus genome in the serum has been reported worldwide among patients with either normal or elevated serum liver enzymes. The characterization of occult HCV infection (OCI) epidemiology in the Middle East and Eastern Mediterranean (M and E) countries, a region with the highest incidence and prevalence rates of HCV infection in the world, would be effective for more appropriate control of the infection.
To estimate the pooled prevalence of OCI in M and E countries using a systematic review and meta-analysis.
A systematic literature search was performed using international, regional and local electronic databases. Some conference proceedings and references from bibliographies were also reviewed manually. The search was carried out during May and June 2020. Original observational surveys were considered if they assessed the prevalence of OCI among the population of M and E countries by examination of HCV nucleic acid in peripheral blood mononuclear cells in at least 30 cases selected by random or non-random sampling methods. The meta-analysis was performed using Comprehensive Meta-analysis software based on heterogeneity assessed by Cochran's test and -square statistics. Data were considered statistically significant at a value < 0.05.
A total of 116 non-duplicated citations were found in electronic sources and grey literature. A total of 51 non-overlapping original surveys were appraised, of which 37 met the inclusion criteria and were included in the analysis. Data were available from 5 of 26 countries including Egypt, Iran, Pakistan, Saudi Arabia, and Turkey. The overall prevalence rate of OCI was estimated at 10.04% (95%CI: 7.66%-13.05%). The lowest OCI rate was observed among healthy subjects (4.79%, 95%CI: 2.86%-7.93%). The higher rates were estimated for patients suffering from chronic liver diseases (12.04%, 95%CI: 5.87%-23.10%), and multi-transfused patients (8.71%, 95%CI: 6.05%-12.39%). Subgroup analysis indicated that the OCI rates were probably not associated with the studied subpopulations, country, year of study, the detection method of HCV RNA, sample size, patients' HCV serostatus, and sex (all > 0.05). Meta-regression analyses showed no significant time trends in OCI rates among different groups.
This review estimated high rates of OCI prevalence in M and E countries, especially among multi-transfused patients as well as patients with chronic liver diseases.
在血清中未检测到病毒基因组的肝组织或外周血单核细胞中存在丙型肝炎病毒（HCV）RNA的情况，在血清肝酶正常或升高的患者中已在全球范围内有报道。中东和东地中海（M和E）国家是世界上丙型肝炎病毒感染发病率和患病率最高的地区，对隐匿性丙型肝炎病毒感染（OCI）流行病学特征进行研究，将有助于更有效地控制该感染。
通过系统评价和荟萃分析估计M和E国家OCI的合并患病率。
使用国际、区域和本地电子数据库进行系统的文献检索。还手动查阅了一些会议论文集和参考文献目录。检索于2020年5月和6月进行。如果原始观察性调查通过随机或非随机抽样方法选择至少30例病例，检测外周血单核细胞中的HCV核酸来评估M和E国家人群中OCI的患病率，则纳入考虑。使用综合荟萃分析软件进行荟萃分析，基于Cochran检验和卡方统计评估异质性。当P值<0.05时，数据被认为具有统计学意义。
在电子资源和灰色文献中总共发现了116条非重复引用。总共评估了51项不重叠的原始调查，其中37项符合纳入标准并纳入分析。数据来自26个国家中的5个，包括埃及、伊朗、巴基斯坦、沙特阿拉伯和土耳其。OCI的总体患病率估计为10.04%（95%CI：7.66%-13.05%）。在健康受试者中观察到最低的OCI率（4.79%，95%CI：2.86%-7.93%）。慢性肝病患者（12.04%，95%CI：5.87%-23.10%）和多次输血患者（8.71%，95%CI：6.05%-12.39%）的患病率估计较高。亚组分析表明，OCI率可能与所研究的亚人群、国家、研究年份、HCV RNA检测方法、样本量、患者的HCV血清学状态和性别均无关（所有P>0.05）。荟萃回归分析显示不同组之间OCI率没有显著的时间趋势。
本综述估计M和E国家的OCI患病率较高，尤其是在多次输血患者以及慢性肝病患者中。
