Hepatitis Delta Prevalence in South America: A Systematic Review and Meta-Analysis

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.

摘要 丁型肝炎病毒（Hepatitis delta virus, HDV）与拉丁美洲地区的急性或慢性肝炎存在关联，但目前尚无覆盖南美洲各国的流行率研究。本荟萃分析旨在通过对2017年12月之前发表的英文、葡萄牙语及西班牙语文献进行系统综述，估算抗HDV抗体（anti-HDV）的流行率。研究按照既定的受试者选择与地理范围标准，在健康虚拟图书馆（Health Virtual Library）、Capes、Lilacs、PubMed及SciELO数据库中开展文献检索。研究质量采用GRADE指南进行评估。采用DerSimonian-Laird随机效应模型结合Freeman-Tukey双反正弦变换，计算合并抗HDV抗体流行率。在检索到的405篇文献中，仅31篇符合本次荟萃分析的纳入标准。在南美洲地区，乙型肝炎病毒（hepatitis B virus, HBV）携带者的合并抗HDV抗体流行率为22.37%（95%置信区间：13.72~32.26）；根据数据收集时间，部分国家和人群中的流行率相对更低。研究结果显示，三十年间抗HDV抗体流行率呈显著持续下降趋势。但亚马逊盆地以外地区，尤其是南美洲西南部，HDV流行病学研究较为匮乏，且目标人群未实现标准化。尽管各研究的方法学特征与研究结局存在差异，但南美洲各国的HDV流行率仍处于较高水平，这凸显了近数十年来HDV流行率的急剧下降。未来研究应明确该大陆其他地区的HDV流行率估算数据，并确定相关危险因素。