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The Global Prevalence of Hepatitis D Virus Infection: Systematic Review and Meta-Analysis
J Hepatol. 2020 Apr 23;S0168-8278(20)30220-8. doi: 10.1016/j.jhep.2020.04.008.Online ahead of print.
Alexander J Stockdale1, Benno Kreuels2, Marc Y R Henrion3, Emanuele Giorgi4, Irene Kyomuhangi4, Catherine de Martel5, Yvan Hutin6, Anna Maria Geretti7
1Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
2College of Medicine, Blantyre, Malawi; University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
3Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
4Centre for Health Informatics, Computing, and Statistics, University of Lancaster, Lancaster, United Kingdom.
5International Agency for Research on Cancer, Lyon, France.
6World Health Organization, Geneva, Switzerland.
7Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom. Electronic address: firstname.lastname@example.org.
Background and aims: There are uncertainties about the epidemic patterns of hepatitis delta virus (HDV) infection and its contribution to the burden of liver disease. We estimated the global prevalence of HDV infection and explored its contribution to the development of cirrhosis and hepatocellular carcinoma (HCC) among hepatitis B surface antigen (HBsAg)-positive people.
Methods: We searched Pubmed, EMBASE and Scopus for studies reporting on total or IgG anti-HDV among HBsAg-positive people. Anti-HDV prevalence was estimated using a binomial mixed model, weighting for study quality and population size. The population attributable fraction (PAF) of HDV to cirrhosis and HCC among HBsAg-positive people was estimated using random-effects models.
Results: We included 282 studies, comprising 376 population samples from 95 countries, which together tested 120,293 HBsAg-positive people for anti-HDV. The estimated anti-HDV prevalence was 4.5% (95% CI 3.6, 5.7) among all HBsAg-positive people and 16.4% (14.6, 18.6) among those attending hepatology clinics. Worldwide, 0.16% (0.11, 0.25) of the general population, totalling 12.0 (8.7, 18.7) million people, were estimated to be anti-HDV positive. Prevalence among HBsAg-positive people was highest in Mongolia, the Republic of Moldova and countries in Western and Middle Africa, and was higher in injecting drug users, haemodialysis recipients, men who have sex with men, commercial sex workers, and those with hepatitis C virus or HIV. Among HBsAg-positive people, preliminary PAF estimates of HDV were 18% (10, 26) for cirrhosis and 20% (8, 33) for HCC.
Conclusions: An estimated 12 million people worldwide have experienced HDV infection, with higher prevalence in certain geographic areas and populations. HDV is a significant contributor to HBV-associated liver disease. More quality data are needed to improve the precisions of burden estimates.