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Adjusted estimate of the prevalence of hepatitis delta virus in 25 countries and territories
Örebro University, School of Medical Sciences. (Polaris Observatory Collaborators)ORCID iD: 0000-0001-7248-0910
2024 (English)In: Journal of Hepatology, ISSN 0168-8278, E-ISSN 1600-0641, Vol. 80, no 2, p. 232-242Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIMS: Hepatitis delta virus (HDV) is a satellite RNA virus that requires the hepatitis B virus (HBV) for assembly and propagation. Individuals infected with HDV progress to advanced liver disease faster than HBV mono-infected individuals. Recent studies have estimated the global prevalence of anti-HDV antibodies among the HBV-infected population to be 5-15%. This study aimed to better understand HDV prevalence at the population level in 25 countries/territories.

METHODS: We conducted a literature review for anti-HDV and HDV-RNA-positive prevalence in HBsAg positive individuals in 25 countries/territories. Virtual meetings were held with experts from each setting to discuss the findings and collect unpublished data. Data were weighted for patient segments and regional heterogeneity to estimate the prevalence in the HBV-infected population. The findings were then combined with The Polaris Observatory HBV data to estimate the anti-HDV & HDV-RNA prevalence in each country/territory at the population level.

RESULTS: After adjusting for geographical distribution, disease stage and special populations, the anti-HDV prevalence among the HBsAg+ population changed from the literature estimate in 19 countries. The highest anti-HDV prevalence was 60.1% in Mongolia. Once adjusted for the HBsAg+ population and HDV-RNA+, China had the highest absolute number of HDV-RNA+ cases.

CONCLUSIONS: We found substantially lower HDV prevalence than previously reported, as prior meta-analyses primarily focused on studies conducted in groups/regions that have a higher probability of HBV infection: tertiary care centers, specific risk groups or geographical regions. There is large uncertainty in HDV prevalence estimates. The implementation of reflex testing would improve estimates, while also allowing earlier linkage to care for HDV RNA+ individuals. The logistical and economic burden of reflex testing on the health system would be limited, as only HBsAg+ cases would be screened.

IMPACT AND IMPLICATIONS: There is a great deal of uncertainty surrounding the prevalence of HDV among people living with HBV at the population level. This study aimed to better understand the burden in 25 countries and territories, to refine techniques that can be used in future analyses. We found a lower prevalence in the majority of places studied than had been previously reported. These data can help inform policy makers on the need to screen people living with HBV to find those coinfected with HDV and at high risk for progression, while also highlighting the pitfalls that other researchers have often fallen into.

Place, publisher, year, edition, pages
Elsevier, 2024. Vol. 80, no 2, p. 232-242
Keywords [en]
Epidemiology, Hepatitis B, Hepatitis D, Hepatitis delta virus, Prevalence, Viral hepatitis
National Category
Infectious Medicine
Identifiers
URN: urn:nbn:se:oru:diva-109964DOI: 10.1016/j.jhep.2023.10.043ISI: 001184424500001PubMedID: 38030035Scopus ID: 2-s2.0-85181735099OAI: oai:DiVA.org:oru-109964DiVA, id: diva2:1815813
Note

Funding Agencies:

Gilead Sciences IN-US-980-6236

John C Martin Foundation 2019-G024

Available from: 2023-11-30 Created: 2023-11-30 Last updated: 2024-04-03Bibliographically approved

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Duberg, Ann-Sofi

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