Estimating the Global Prevalence, Disease Progression, and Clinical Outcome of Hepatitis Delta Virus Infection

Abstract Background Hepatitis delta virus (HDV) coinfects 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 cl...

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Published in:	The Journal of infectious diseases Vol. 221; no. 10; pp. 1677 - 1687
Main Authors:	Miao, Zhijiang, Zhang, Shaoshi, Ou, Xumin, Li, Shan, Ma, Zhongren, Wang, Wenshi, Peppelenbosch, Maikel P, Liu, Jiaye, Pan, Qiuwei
Format:	Journal Article
Language:	English
Published:	US Oxford University Press 27.04.2020
Subjects:	Developing Countries Global Health Hepatitis D - epidemiology Hepatitis D - pathology Hepatitis D - virology Hepatitis Delta Virus Humans Prevalence Risk Factors epidemiology disease progression cirrhosis hepatitis delta virus hepatocellular carcinoma
ISSN:	0022-1899, 1537-6613, 1537-6613
Online Access:	Get full text
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Abstract	Abstract Background Hepatitis delta virus (HDV) coinfects 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. Methods We conducted a meta-analysis with a random-effects model and performed data synthesis. Results The pooled prevalence of HDV is 0.80% (95% confidence interval [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 with asymptomatic controls is 4.55 (95% CI, 3.65–5.67). Hepatitis delta virus-coinfected patients are more likely to develop cirrhosis than HBV-monoinfected 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, on average. Conclusions Findings suggest that HDV poses a heavy global burden with rapid progression to severe liver diseases, urging effective strategies for screening, prevention, and treatment. Forty-eight to 60 million individuals are infected with HDV around the globe, and Asia and Africa are the worst-hit areas. HDV infection predisposes to rapid progression into severe liver diseases, particularly liver cirrhosis.
AbstractList	Hepatitis delta virus (HDV) coinfects 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.BACKGROUNDHepatitis delta virus (HDV) coinfects 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.METHODSWe conducted a meta-analysis with a random-effects model and performed data synthesis.The pooled prevalence of HDV is 0.80% (95% confidence interval [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 with asymptomatic controls is 4.55 (95% CI, 3.65-5.67). Hepatitis delta virus-coinfected patients are more likely to develop cirrhosis than HBV-monoinfected 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, on average.RESULTSThe pooled prevalence of HDV is 0.80% (95% confidence interval [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 with asymptomatic controls is 4.55 (95% CI, 3.65-5.67). Hepatitis delta virus-coinfected patients are more likely to develop cirrhosis than HBV-monoinfected 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, on 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.CONCLUSIONSFindings suggest that HDV poses a heavy global burden with rapid progression to severe liver diseases, urging effective strategies for screening, prevention, and treatment. Hepatitis delta virus (HDV) coinfects 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% confidence interval [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 with asymptomatic controls is 4.55 (95% CI, 3.65-5.67). Hepatitis delta virus-coinfected patients are more likely to develop cirrhosis than HBV-monoinfected 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, on 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. Abstract Background Hepatitis delta virus (HDV) coinfects 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. Methods We conducted a meta-analysis with a random-effects model and performed data synthesis. Results The pooled prevalence of HDV is 0.80% (95% confidence interval [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 with asymptomatic controls is 4.55 (95% CI, 3.65–5.67). Hepatitis delta virus-coinfected patients are more likely to develop cirrhosis than HBV-monoinfected 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, on average. Conclusions Findings suggest that HDV poses a heavy global burden with rapid progression to severe liver diseases, urging effective strategies for screening, prevention, and treatment. Forty-eight to 60 million individuals are infected with HDV around the globe, and Asia and Africa are the worst-hit areas. HDV infection predisposes to rapid progression into severe liver diseases, particularly liver cirrhosis.
Author	Miao, Zhijiang Peppelenbosch, Maikel P Zhang, Shaoshi Li, Shan Ma, Zhongren Ou, Xumin Wang, Wenshi Pan, Qiuwei Liu, Jiaye
Author_xml	– sequence: 1 givenname: Zhijiang surname: Miao fullname: Miao, Zhijiang organization: Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands – sequence: 2 givenname: Shaoshi surname: Zhang fullname: Zhang, Shaoshi organization: Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands – sequence: 3 givenname: Xumin surname: Ou fullname: Ou, Xumin organization: Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands – sequence: 4 givenname: Shan surname: Li fullname: Li, Shan organization: Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands – sequence: 5 givenname: Zhongren surname: Ma fullname: Ma, Zhongren organization: Biomedical Research Center, Northwest Minzu University, Lanzhou, People’s Republic of China – sequence: 6 givenname: Wenshi surname: Wang fullname: Wang, Wenshi organization: Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands – sequence: 7 givenname: Maikel P surname: Peppelenbosch fullname: Peppelenbosch, Maikel P organization: Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands – sequence: 8 givenname: Jiaye surname: Liu fullname: Liu, Jiaye email: q.pan@erasmusmc.nl organization: Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands – sequence: 9 givenname: Qiuwei surname: Pan fullname: Pan, Qiuwei email: q.pan@erasmusmc.nl organization: Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/31778167$$D View this record in MEDLINE/PubMed
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ContentType	Journal Article
Copyright	The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. 2019 The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.
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Keywords	epidemiology disease progression cirrhosis hepatitis delta virus hepatocellular carcinoma
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License	This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.
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Snippet	Abstract Background Hepatitis delta virus (HDV) coinfects with hepatitis B virus (HBV) causing the most severe form of viral hepatitis. However, its exact... Hepatitis delta virus (HDV) coinfects with hepatitis B virus (HBV) causing the most severe form of viral hepatitis. However, its exact global disease burden...
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SubjectTerms	Developing Countries Global Health Hepatitis D - epidemiology Hepatitis D - pathology Hepatitis D - virology Hepatitis Delta Virus Humans Prevalence Risk Factors
Title	Estimating the Global Prevalence, Disease Progression, and Clinical Outcome of Hepatitis Delta Virus Infection
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