Prevalence of hepatitis D virus infection in sub-Saharan Africa: a systematic review and meta-analysis

Abstract

SummaryBackgroundHepatitis D virus (also known as hepatitis delta virus) can establish a persistent infection in people with chronic hepatitis B, leading to accelerated progression of liver disease. In sub-Saharan Africa, where HBsAg prevalence is higher than 8%, hepatitis D virus might represent an important additive cause of chronic liver disease. We aimed to establish the prevalence of hepatitis D virus among HBsAg-positive populations in sub-Saharan Africa.MethodsWe systematically reviewed studies of hepatitis D virus prevalence among HBsAg-positive populations in sub-Saharan Africa. We searched PubMed, Embase, and Scopus for papers published between Jan 1, 1995, and Aug 30, 2016, in which patient selection criteria and geographical setting were described. Search strings included sub-Saharan Africa, the countries therein, and permutations of hepatitis D virus. Cohort data were also added from HIV-positive populations in Malawi and Ghana. Populations undergoing assessment in liver disease clinics and those sampled from other populations (defined as general populations) were analysed. We did a meta-analysis with a DerSimonian-Laird random-effects model to calculate a pooled estimate of hepatitis D virus seroprevalence.FindingsOf 374 studies identified by our search, 30 were included in our study, only eight of which included detection of hepatitis D virus RNA among anti-hepatitis D virus seropositive participants. In west Africa, the pooled seroprevalence of hepatitis D virus was 7·33% (95% CI 3·55–12·20) in general populations and 9·57% (2·31–20·43) in liver-disease populations. In central Africa, seroprevalence was 25·64% (12·09–42·00) in general populations and 37·77% (12·13–67·54) in liver-disease populations. In east and southern Africa, seroprevalence was 0·05% (0·00–1·78) in general populations. The odds ratio for anti-hepatitis D virus detection among HBsAg-positive patients with liver fibrosis or hepatocellular carcinoma was 5·24 (95% CI 2·74–10·01; p<0·0001) relative to asymptomatic controls.InterpretationFindings suggest localised clusters of hepatitis D virus endemicity across sub-Saharan Africa. Epidemiological data are needed from southern and east Africa, and from patients with established liver disease. Further studies should aim to define the reliability of hepatitis D virus testing methods, identify risk factors for transmission, and characterise the natural history of the infection in the region.FundingWellcome Trust, Royal Society.

Etiology of hepatocellular carcinoma in West Africa, a case–control study

“…The prevalence of HDV reported in the present study is concordant with results from a recent systematic review where pooled HDV seroprevalence ranged from 7.3% (CI 3.5–12.2) in the general population to 9.6% (CI 2.3–20.4) in liver‐disease population across West Africa . Interestingly, marked differences in HDV prevalence were reported according to countries.…”

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

“…This could partly explain the geographical distribution of HDV 5. Whereas the risk behaviour of homosexuals will raise the susceptibility of HCV infection,27 HCV coinfection and liver disease are said to be the additional risk factors for HDV infection 28. In our study, patients with liver disease had a higher prevalence than HBsAg carriers (online supplementary appendix figure S2).…”

“…Additionally, issues with use of unscreened blood products, unsafe medical procedures and restricted access to antiviral treatments still remain to be solved in poor-resourced countries 1. Studies have shown that the immigrant children have lower immunisation coverage and higher HBV prevalence than native ones, which implies immigrants may have limited access to medical care which is true especially for illegal immigrants 28. More attention is needed to be paid to global HBV vaccination programme, as our result showed that the decline in HDV infection is most likely due to the successful implementation of HBV vaccination programme.…”

Devil hepatitis D: an orphan disease or largely underdiagnosed?

“…Inclusion or exclusion of studies may be justified based on prespecified criteria but even if high standards are applied the outcome of systematic reviews can be surprisingly different. This is also the case here where data for Africa suggested by Chen et al differed from a recent systematic review and meta-analysis focusing on Africa 11. In that study, two publications from Benin and Somalia reporting higher HDV seroprevalences were not considered.…”