Journal
JOURNAL OF INFECTIOUS DISEASES
Volume 221, Issue 10, Pages 1677-1687Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/infdis/jiz633
Keywords
cirrhosis; disease progression; epidemiology; hepatitis delta virus; hepatocellular carcinoma
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Funding
- Dutch Cancer Society [10140]
- Netherlands Organization for Scientific Research (NWO), VIDI Grant [91719300]
- China Scholarship Council [201708530234, 201706910003, 201408060053, 201606240079]
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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.
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