Prevalence and burden of hepatitis D virus infection in the global population: a systematic review and meta-analysis

• Published in: Gut Vol. 68; no. 3; pp. 512 - 521
• Main Authors: Chen, Hai-Yan, Shen, Dan-Ting, Ji, Dong-Ze, Han, Pei-Chun, Zhang, Wei-Ming, Ma, Jian-Feng, Chen, Wen-Sen, Goyal, Hemant, Pan, Shiyang, Xu, Hua-Guo
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.03.2019
• Subjects: Coinfection - epidemiology; Data processing; Epidemiology; Global Health - statistics & numerical data; Hepatitis; Hepatitis B; Hepatitis B surface antigen; Hepatitis B Surface Antigens - blood; Hepatitis B, Chronic - epidemiology; Hepatitis D - epidemiology; Hepatitis D - transmission; Hepatitis delta virus; Hepatology; Humans; Infections; Intravenous administration; Life cycles; Liver cancer; Meta-analysis; Mortality; Population; Population studies; Prevalence; Risk Factors; Risk-Taking; Serology; Sexual Behavior; Studies; Substance Abuse, Intravenous - complications; Substance Abuse, Intravenous - epidemiology; Superinfection; Systematic review; China; Africa; meta-analysis; hepatitis B; hepatitis D
• DOI: 10.1136/gutjnl-2018-316601
• ISSN: 0017-5749; 1468-3288

ObjectiveHepatitis D virus (HDV) is a defective virus that completes its life cycle only with hepatitis B virus (HBV). The HBV with HDV super-infection has been considered as one of the most severe forms of the chronic viral hepatitis. However, there is a scarcity of data on the global burden of HDV infection.DesignWe searched PubMed, Embase, Cochrane Library and China Knowledge Resource Integrated databases from 1 January 1977 to 31 December 2016. We included studies with a minimum sample size of 50 patients. Our study analysed data from a total of 40 million individuals to estimate the prevalence of HDV by using Der-Simonian Laird random-effects model. The data were further categorised according to risk factors.ResultsFrom a total of 2717 initially identified studies, only 182 articles from 61 countries and regions met the final inclusion criteria. The overall prevalence of HDV was 0.98% (95% CI 0.61 to 1.42). In HBsAg-positive population, HDV pooled prevalence was 14.57% (95% CI 12.93 to 16.27): Seroprevalence was 10.58% (95% CI 9.14 to 12.11) in mixed population without risk factors of intravenous drug use (IVDU) and high-risk sexual behaviour (HRSB). It was 37.57% (95% CI 29.30 to 46.20) in the IVDU population and 17.01% (95% CI 10.69 to 24.34) in HRSB population.ConclusionWe found that approximately 10.58% HBsAg carriers (without IVDU and HRSB) were coinfected with HDV, which is twofold of what has been estimated before. We also noted a substantially higher HDV prevalence in the IVDU and HRSB population. Our study highlights the need for increased focus on the routine HDV screening and rigorous implementation of HBV vaccine programme.