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

Background. Hepatitis D virus (HDV) infection has been considered a serious neglected pandemic, particularly in developingcountries. The virus causes a more severe disease than mono infection with hepatitis B virus (HBV). The epidemiology of HDVis not well documented in North Africa, which is known to be endemic for HBV. In this study, we explored the prevalence ofHDV infection and also attempted to identify factors associated with hepatitis D positive status among chronic hepatitis B patientsin North Africa.Methods. The electronic databases PubMed, Embase, Scopus, Science Direct, Web of Science, and Google Scholarwere comprehensively searched for all papers published between January 1, 1998, and December 31, 2017, using appropriate strategiescontaining 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 countryweighted by the ratio of the country’s hepatitis D virus population to the study’s sample size in the survey data analysis.Findings.Atotal of 312 studies were identified and 32 were included in this study, with a total sample of 4907 individuals screened for HDV. Therewas considerable variability in the prevalence estimates of HDV within the countries of the region. The overall prevalence of HDV inthe 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 participantswho were seropositive for HDV, and four studies highlighted the impact of demographic factors (sex and age). No study showed theimpact of risk factors on the prevalence of HDV in North Africa.Interpretation. This review provides a comprehensive assessmentof the burden of HDV in Northern Africa. There were significant differences in seroprevalence, study population, and diagnostictesting between the countries in the region. The results presented here will alert health professionals to implement clear policiesbased on evidence to diminish the burden of HDV infection. Such measures may include but are not restricted to improvingthe laboratory diagnostic tests and initiating patient data registries and blood screening. Further epidemiological and researchstudies 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 NorthAfrica.