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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Summary: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.
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ISSN:0022-1899
1537-6613
1537-6613
DOI:10.1093/infdis/jiz633