Abstract
Hepatitis delta virus (HDV) has been associated with acute or chronic hepatitis in Latin America, but there is no prevalence study covering South American countries. This meta-analysis aimed to estimate anti-HDV prevalence through a systematic review of published articles in English, Portuguese and Spanish until December 2017. Searches were conducted in Health Virtual Library, Capes, Lilacs, PubMed, and SciELO, according to defined criteria regarding participant selection and geographical setting. Study quality was assessed using the GRADE guidelines. Pooled anti-HDV prevalence was calculated using the DerSimonian-Laird random-effects model with Freeman-Tukey double arcsine transformation. Out of the 405 identified articles, only 31 met the eligibility criteria for inclusion in the meta-analysis. In South America, pooled anti-HDV prevalence among hepatitis B virus carriers was 22.37% (95% confidence interval: 13.72-32.26), though it appeared less frequently in some countries and populations, according to the data collection date. The findings indicated significant successive reductions in anti-HDV prevalence over thirty years. However, there was a scarcity of HDV epidemiological studies outside the Amazon Basin, notably in the Southwest continent and absence of target population standardization. There was a high HDV prevalence in South American countries, despite differences in methodological characteristics and outcomes, highlighting a drastic decline in the last decades. Future studies should identify HDV prevalence estimates in other regions of the continent and identify risk factors.
Highlights
Hepatitis delta virus (HDV) infection can cause acute or chronic hepatitis
No HDV infection case was reported in one study with injecting drug users from Rio de Janeiro, Brazil[28], whereas in another study conducted in a school community in Peru, the anti-HDV prevalence was 16.67%29. This is the first systematic review to perform a meta-analysis on HDV infection prevalence in several populations, whose focus was on South America
This review is important for the better understanding of current HDVinfection geographical distribution between South American countries, notably, in highly endemic areas and with acute and chronic cases recorded over a 30-year period[1, 2, 49, 50]
Summary
Hepatitis delta virus (HDV) infection can cause acute or chronic hepatitis. HDV is a defective virus capable of multiplying only in hepatitis B virus (HBV) infected hepatocytes, requiring HBV surface antigen (HBsAg) as its envelope protein[1]. 1-12 Even in endemic areas, anti-HDV prevalence differs greatly depending on geographical region, such as in the Eastern Mediterranean[5], sub-Saharan Africa[12], Iran[4], and Turkey[6]. In Latin America, HDV has been associated with acute and chronic infection, severe and fulminant hepatitis. The study area was based on articles already reporting high HDV endemicity in South America, since the 1980s13-19. 20-22 To date, there has been no HDV infection prevalence estimate for South America. A systematic review with metaanalysis was planned to provide a clearer and more comprehensive
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