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    The adjusted prevalence of hepatitis delta virus (HDV) in 25 countries and territories
    (Elsevier, 2024) Razavi-Shearer, Devin; Child, H.; Razavi-Shearer, K.; Voeller, A.; Razavi, H.; Örmeci, Necati; Wu, J-C.; Yang, H-I.; Yu, M-L.; Yuen, M-F.; Yurdaydın, C.; Zuckerman, E.
    Background and aims: Hepatitis delta virus (HDV) is a satellite RNA virus that requires the hepatitis B virus (HBV) for assembly and propagation. Individuals infected with HDV progress to advanced liver disease faster than HBV mono-infected individuals. Recent studies have estimated the global prevalence of anti-HDV antibodies among the HBV-infected population to be 5-15%. This study aimed to better understand HDV prevalence at the population level in 25 countries/territories. Methods: We conducted a literature review for anti-HDV and HDV-RNA-positive prevalence in HBsAg positive individuals in 25 countries/territories. Virtual meetings were held with experts from each setting to discuss the findings and collect unpublished data. Data were weighted for patient segments and regional heterogeneity to estimate the prevalence in the HBV-infected population. The findings were then combined with The Polaris Observatory HBV data to estimate the anti-HDV & HDV-RNA prevalence in each country/territory at the population level. Results: After adjusting for geographical distribution, disease stage and special populations, the anti-HDV prevalence among the HBsAg+ population changed from the literature estimate in 19 countries. The highest anti-HDV prevalence was 60.1% in Mongolia. Once adjusted for the HBsAg+ population and HDV-RNA+, China had the highest absolute number of HDV-RNA+ cases. Conclusions: We found substantially lower HDV prevalence than previously reported, as prior meta-analyses primarily focused on studies conducted in groups/regions that have a higher probability of HBV infection: tertiary care centers, specific risk groups or geographical regions. There is large uncertainty in HDV prevalence. The implementation of reflex testing would improve estimates, while also allowing earlier linkage to care for HDV-RNA-positive individuals. The logistical and economic burden of reflex testing on the health system would be limited, as it would only screen HBsAg+ cases. Impact and implications: There is a great deal of uncertainty surrounding the prevalence of HDV among people living with HBV at the population level. This study aimed to better understand the burden in 25 countries and territories, to refine techniques that can be used in future analyses. We found a lower prevalence in the majority of places studied than had been previously reported. These data can help inform policy makers on the need to screen people living with HBV to find those coinfected with HDV and at high risk for progression, while also highlighting the pitfalls that other researchers have often fallen into.
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    Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling study
    (Elsevier, 2023) Razavi-Shearer, Devin; Gamkrelidze, Ivane; Pan, Calvin; Jia, Jidong; Berg, Thomas; Gray, Richard; Lim, Young-Suk; Chen, Chien-Jen; Ocama, Ponsiano; Mekonnen, Hailemichael; Abbas, Zaigham; Abdallah, Ayat; Örmeci, Necati; Razavi, Homie
    Background The 2016 World Health Assembly endorsed the elimination of hepatitis B virus (HBV) infection as a public health threat by 2030; existing therapies and prophylaxis measures make such elimination feasible, even in the absence of a virological cure. We aimed to estimate the national, regional, and global prevalence of HBV in the general population and among children aged 5 years and younger, as well as the rates of diagnosis, treatment, prophylaxis, and the future burden globally. Methods In this modelling study, we used a Delphi process with data from literature reviews and interviews with country experts to quantify the prevalence, diagnosis, treatment, and prevention measures for HBV infection. The PRoGReSs Model, a dynamic Markov model, was used to estimate the country, regional, and global prevalence of HBV infection in 2022, and the effects of treatment and prevention on disease burden. The future incidence of morbidity and mortality in the absence of additional interventions was also estimated at the global level. Findings We developed models for 170 countries which resulted in an estimated global prevalence of HBV infection in 2022 of 3·2% (95% uncertainty interval 2·7–4·0), corresponding to 257·5 million (216·6–316·4) individuals positive for HBsAg. Of these individuals, 36·0 million were diagnosed, and only 6·8 million of the estimated 83·3 million eligible for treatment were on treatment. The prevalence among children aged 5 years or younger was estimated to be 0·7% (0·6–1·0), corresponding to 5·6 million (4·5–7·8) children with HBV infection. Based on the most recent data, 85% of infants received three-dose HBV vaccination before 1 year of age, 46% had received a timely birth dose of vaccine, and 14% received hepatitis B immunoglobulin along with the full vaccination regimen. 3% of mothers with a high HBV viral load received antiviral treatment to reduce mother-to-child transmission. Interpretation As 2030 approaches, the elimination targets remain out of reach for many countries under the current frameworks. Although prevention measures have had the most success, there is a need to increase these efforts and to increase diagnosis and treatment to work towards the elimination goals.