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.

Additional Metadata
Keywords cirrhosis, disease progression, epidemiology, hepatitis delta virus, hepatocellular carcinoma
Persistent URL dx.doi.org/10.1093/infdis/jiz633, hdl.handle.net/1765/128532
Journal The Journal of Infectious Diseases
Organisation Rotterdam Institute of Law and Economics
Citation
Miao, Z.J, Zhang, S, Ou, X.M, Li, S, Ma, Z.R, Wang, W, … Pan, Q. (2019). Estimating the Global Prevalence, Disease Progression, and Clinical Outcome of Hepatitis Delta Virus Infection. The Journal of Infectious Diseases, 221(10), 1677–1687. doi:10.1093/infdis/jiz633