The Epidemiology of Hepatitis D Virus in North Africa: A Systematic Review and Meta-Analysis

Abstract

Background Hepatitis D virus (HDV) infection has been considered a serious neglected pandemic, particularly in developing countries. The virus causes a more severe disease than mono infection with hepatitis B virus (HBV). The epidemiology of HDV is not well documented in North Africa, which is known to be endemic for HBV. In this study, we explored the prevalence of HDV infection and also attempted to identify factors associated with hepatitis D positive status among chronic hepatitis B patients in North Africa. Methods The electronic databases PubMed, Embase, Scopus, Science Direct, Web of Science, and Google Scholar were comprehensively searched for all papers published between January 1, 1998, and December 31, 2017, using appropriate strategies containing all related keywords, including North Africa, names of countries in the region, and all permutations of hepatitis D virus. The estimated prevalence of HDV in North Africa was calculated as an average of the pooled infection prevalence in each country weighted by the ratio of the country's hepatitis D virus population to the study's sample size in the survey data analysis. Findings A total of 312 studies were identified and 32 were included in this study, with a total sample of 4907 individuals screened for HDV. There was considerable variability in the prevalence estimates of HDV within the countries of the region. The overall prevalence of HDV in the general population of North Africa was 5·01% (95% CI: 1·25–8·27) and in liver disease patients it was 20.7% (95% CI:9.87–44.53). Genotype-1 was the most prominent genotype reported in five published studies. Ten studies reported on HDV RNA in participants who were seropositive for HDV, and four studies highlighted the impact of demographic factors (sex and age). No study showed the impact of risk factors on the prevalence of HDV in North Africa. Interpretation This review provides a comprehensive assessment of the burden of HDV in Northern Africa. There were significant differences in seroprevalence, study population, and diagnostic testing between the countries in the region. The results presented here will alert health professionals to implement clear policies based on evidence to diminish the burden of HDV infection. Such measures may include but are not restricted to improving the laboratory diagnostic tests and initiating patient data registries and blood screening. Further epidemiological and research studies are needed to explore the risk factors, coinfections, and approaches to increase testing for HDV, particularly in high-risk subpopulations, such as intravenous drug users and immigrants, and to define the consequences of HDV infection in North Africa.

The geographic variation and spatiotemporal distribution of hepatitis C virus infection in Libya: 2007–2016

“…HCV infections are particularly more prevalent in the southern and eastern districts, but this could have been due to the increasing number of African immigrants in these regions. Hence, further studies are needed at the regional level within North and sub-Saharan countries bordering Libya, particularly Egypt, Sudan, Chad and Niger to shed light on the population-related determinants that may play a role in the upsurge of HCV and other concomitant infections in North Africa [ 42 , 43 ].…”

A systematic review and meta-analysis of the prevalence, trends and spatiotemporal distribution of HIV/AIDS infection in Northern African countries.

“…Publication bias was assessed by inspection of a funnel plot and Egger's test. Analyses of aggregated prevalence of each country were done with metan, command in which is an average of the individual study results weighted by the inverse of their variances using a x/random model [19].…”

HDV infection in immigrant populations

“…HDV infection is spread all over the world, with different frequencies in different geographical areas. Globally, it is estimated that 5% of HBsAg carriers are also infected with HDV, suggesting that 15 to 20 million people are chronic carriers of HBV/HDV coinfection . HBV and HDV have similar transmission routes: sexual (via semen or vaginal secretions), parenteral (needle‐stick injuries, injection drug use, and transfusions), and perinatal.…”

“…A systematic review of the prevalence of HDV infection in HBsAg‐positive populations in sub‐Saharan Africa has shown the following pooled seroprevalence: 7.33% in general populations and 9.57% in patients with liver disease in western Africa, 25.6% in the general populations and 37.8% in liver‐disease populations in central Africa and 0.05% in the general populations of eastern and southern Africa . Further relevant information on HDV endemicity in Africa comes from a recent meta‐analysis regarding the data of north‐African countries showing an overall prevalence of HDV infection in HBsAg chronic carriers of 5% in the general populations and of 20.7% in patients with liver disease …”

“…Globally, it is estimated that 5% of HBsAg carriers are also infected with HDV, suggesting that 15 to 20 million people are chronic carriers of HBV/HDV coinfection. [95][96][97][98][99][100][101][102][103][104][105][106][107][108][109][110][111][112] HBV and HDV have similar transmission routes: sexual (via semen or vaginal secretions), parenteral (needle-stick injuries, injection drug use, and transfusions), and perinatal. The intrafamily spread of HBV and HDV infection is very common in highly endemic regions.…”