Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2018 Sep 26:2018:9312650.
doi: 10.1155/2018/9312650. eCollection 2018.

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

Mohamed A Daw  1 , Amina M Daw  2 , Nadia E M Sifennasr  1 , Aisha M Draha  3 , Ahmed M Daw  4 , Ali M Daw  4 , Mohamed O Ahmed  5 , Ebtisam S Mokhtar  1 , Abdallah El-Bouzedi  6 , Ibrahem M Daw  7
Affiliations
Meta-Analysis

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

Mohamed A Daw et al. ScientificWorldJournal. .

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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow chart of article selection for the systematic review and meta-analysis of hepatitis D virus epidemiology in North Africa (1998-2017).
Figure 2
Figure 2
Seroepidemiology of hepatitis D virus in North African populations in studies published during 1998–2017.
Figure 3
Figure 3
Forest plot of the seroprevalence of hepatitis D virus in different populations in North Africa.
See this image and copyright information in PMC

References

    1. Botelho-Souza L. F., Vasconcelos M. P. A., Dos Santos A. D. O., Salcedo J. M. V., Vieira D. S. Hepatitis delta: Virological and clinical aspects. Virology Journal. 2017;14(1) - PMC - PubMed
    1. Wedemeyer H., Manns M. P. Epidemiology, pathogenesis and management of hepatitis D: Update and challenges ahead. Nature Reviews Gastroenterology & Hepatology. 2010;7(1):31–40. doi: 10.1038/nrgastro.2009.205. - DOI - PubMed
    1. Bonino F., Heermann K. H., Rizzetto M., Gerlich W. H. Hepatitis delta virus: Protein composition of delta antigen and its hepatitis B virus-derived envelope. Journal of Virology. 1986;58(3):945–950. - PMC - PubMed
    1. Alfaiate D., Negro F. Nucleic acid polymers: much-needed hope for hepatitis D? The Lancet Gastroenterology & Hepatology. 2017;2(12):841–842. doi: 10.1016/S2468-1253(17)30292-3. - DOI - PubMed
    1. Kos A., Dijkema R., Arnberg A. C., Van Der Meide P. H., Schellekens H. The hepatitis delta (δ) virus possesses a circular RNA. Nature. 1986;323(6088):558–560. doi: 10.1038/323558a0. - DOI - PubMed

MeSH terms

LinkOut - more resources