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The global prevalence of hepatitis D virus infection: systematic review and metaanalysis

Research output: Contribution to journalJournal articlepeer-review

<mark>Journal publication date</mark>1/09/2020
<mark>Journal</mark>Journal of Hepatology
Issue number3
Number of pages10
Pages (from-to)523-532
Publication StatusPublished
Early online date23/04/20
<mark>Original language</mark>English


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.
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.
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.
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.