1 Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
2 Department of Hepatobiliary Surgery, Daping Hospital (Army Medical Center), Third Military Medical University (Army medical university), Chongqing, China.
3 Biomedical Research Center, Northwest Minzu University, Lanzhou, PR China.
4 Department of Infectious Diseases, Molecular Virology, University Hospital Heidelberg, Heidelberg, Germany.
Hepatitis delta virus (HDV) co-infects with hepatitis B virus (HBV) causing the most severe form of viral hepatitis. However, its exact global disease burden remains largely obscure. We aim to establish the global epidemiology, infection mode-stratified disease progression and clinical outcome of HDV infection.
We conducted a meta-analysis with a random-effects model, and performed data synthesis.
The pooled prevalence of HDV is 0.80% (95% CI 0.63-1.00) among the general population and 13.02% (95% CI 11.96-14.11) among HBV carriers, corresponding to 48-60 million infections globally. Among HBV patients with fulminant hepatitis, cirrhosis or hepatocellular carcinoma, HDV prevalence is 26.75% (95% CI 19.84-34.29), 25.77% (95% CI 20.62-31.27), and 19.80% (95% CI 10.97-30.45), respectively. The odds ratio (OR) of HDV infection among HBV patients with chronic liver disease compared to asymptomatic controls is 4.55 (95% CI 3.65-5.67). HDV co-infected patients are more likely to develop cirrhosis than HBV mono-infected patients with OR of 3.84 (95% CI 1.79-8.24). Overall, HDV infection progresses to cirrhosis within 5 years, and to hepatocellular carcinoma within 10 years in average.
Findings suggest that HDV poses a heavy global burden with rapid progression to severe liver diseases, urging effective strategies for screening, prevention and treatment.