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Prevalence and burden of hepatitis D virus infection in the global population: a systematic review and meta-analysis
  1. Hai-Yan Chen1,
  2. Dan-Ting Shen1,
  3. Dong-Ze Ji2,
  4. Pei-Chun Han1,
  5. Wei-Ming Zhang2,
  6. Jian-Feng Ma1,
  7. Wen-Sen Chen3,
  8. Hemant Goyal4,
  9. Shiyang Pan1,
  10. Hua-Guo Xu1
  1. 1 Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
  2. 2 Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
  3. 3 Department of Infection Control and Hospital Epidemiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
  4. 4 Department of Internal Medicine, Mercer University School of Medicine, Macon, Georgia, USA
  1. Correspondence to Dr Shiyang Pan and Dr Hua-Guo Xu, Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; sypan{at}, huaguoxu{at}


Objective Hepatitis D virus (HDV) is a defective virus that completes its life cycle only with hepatitis B virus (HBV). The HBV with HDV super-infection has been considered as one of the most severe forms of the chronic viral hepatitis. However, there is a scarcity of data on the global burden of HDV infection.

Design We searched PubMed, Embase, Cochrane Library and China Knowledge Resource Integrated databases from 1 January 1977 to 31 December 2016. We included studies with a minimum sample size of 50 patients. Our study analysed data from a total of 40 million individuals to estimate the prevalence of HDV by using Der-Simonian Laird random-effects model. The data were further categorised according to risk factors.

Results From a total of 2717 initially identified studies, only 182 articles from 61 countries and regions met the final inclusion criteria. The overall prevalence of HDV was 0.98% (95% CI 0.61 to 1.42). In HBsAg-positive population, HDV pooled prevalence was 14.57% (95% CI 12.93 to 16.27): Seroprevalence was 10.58% (95% CI 9.14 to 12.11) in mixed population without risk factors of intravenous drug use (IVDU) and high-risk sexual behaviour (HRSB). It was 37.57% (95% CI 29.30 to 46.20) in the IVDU population and 17.01% (95% CI 10.69 to 24.34) in HRSB population.

Conclusion We found that approximately 10.58% HBsAg carriers (without IVDU and HRSB) were coinfected with HDV, which is twofold of what has been estimated before. We also noted a substantially higher HDV prevalence in the IVDU and HRSB population. Our study highlights the need for increased focus on the routine HDV screening and rigorous implementation of HBV vaccine programme.

  • hepatitis D
  • hepatitis B
  • meta-analysis

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  • H-YC, D-TS and D-ZJ contributed equally.

  • Contributors All authors contributed to the draft and have seen and approved the final version of the report.

  • Funding This work was supported by the National Natural Science Foundation of China (81302531), Natural Science Foundation of Jiangsu Province of China (BK20131018), the Talents Planning of Six Summit Fields of Jiangsu Province (2013-WSN-037), Postgraduate Research & Practice Innovation Program of Jiangsu Province (KYCX17_1287), the National Key Clinical Department of Laboratory Medicine of China in Nanjing, Key laboratory for Laboratory Medicine of Jiangsu Province (ZDXKB2016005) and by the Priority Academic Program Development of Jiangsu Higher Education Institutions.

  • Disclaimer The funder of the study had no role in the study design, data collection, data analysis, data interpretation or writing of the manuscript. The corresponding author had full access to all the data in the study and has final responsibility for the decision to submit for publication.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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