Prevalence, Risk Factors, and Clinical Profiles of Hepatitis D Virus in Nigeria: A Systematic Review, 2009-2024

• Published in: Viruses 2024-10, Vol.16 (11), p.1723
• Main Authors: Adepoju, Victor Abiola, Udah, Donald Chinazor, Adnani, Qorinah Estiningtyas Sakilah
• Format: Article
• Language: English
• Subjects: Adult; Antibodies; Antigens; CD4 antigen; Cell culture; Chronic infection; Cirrhosis; co-infection; Coinfection - epidemiology; Coinfection - virology; Comorbidity; Cross-Sectional Studies; Delta infection; Development and progression; Diagnosis; Epidemiology; Female; Gender; Hepatitis B; Hepatitis B virus - genetics; Hepatitis B, Chronic - epidemiology; Hepatitis B, Chronic - virology; Hepatitis D; Hepatitis D - epidemiology; Hepatitis delta virus; Hepatitis Delta Virus - genetics; Hepatitis Delta Virus - immunology; Hepatocellular carcinoma; Hepatocytes; HIV; Human immunodeficiency virus; Humans; Immunization; Immunoglobulin G; Immunoglobulin M; Infections; Liver cancer; Liver cirrhosis; Liver diseases; liver enzyme; Male; Morbidity; Nigeria - epidemiology; Observational studies; Patients; Prevalence; Public health; Review; Ribonucleic acid; Risk Factors; RNA; RNA polymerase; Sexual partners; Systematic review; viral hepatitis; Viral infections; Viremia; Viruses
• ISSN: 1999-4915; 1999-4915
• DOI: 10.3390/v16111723

The World Health Organization (WHO) recommends hepatitis D virus (HDV) screening among hepatitis B virus (HBV) infected individuals, with a focus on priority populations in resource-limited settings like Nigeria. HDV infection is a growing public health challenge, particularly among individuals with chronic hepatitis B virus (HBV) infection. HDV accelerates liver disease progression and significantly increases the risk of cirrhosis and hepatocellular carcinoma. Despite this, the epidemiology of HDV in Nigeria remains inadequately documented. This scoping review critically evaluates the prevalence, risk factors, and clinical outcomes of HDV co-infection among HBV patients in Nigeria. We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The review included observational cross-sectional studies published between 2009 and 2024. We focused on studies that used Immunoglobulin G (IgG) antibody testing or RNA-based diagnostics to assess HDV prevalence. We included PubMed, Google Scholar, and Dimensions databases due to their broad indexing and coverage of peer-reviewed articles and accessibility. We screened the studies for their relevance to HDV prevalence, risk factors, and clinical outcomes, while excluding those that only tested for IgM or HDV antigen. Eleven studies, with a combined sample size of 2308 participants, were included in the final analysis. We performed a narrative synthesis of the findings, considering geographic, gender, and age-based variations in HDV prevalence and clinical impact. HDV prevalence among HBV-infected individuals in Nigeria ranged from 2.0% to 31.6%. The highest prevalence was reported in the Southwest (31.6%) among malaria patients, while lower rates were observed in the Southeast (2.8%). Prevalence was higher in males, particularly those aged 21-30 years in the Southwest and 31-40 years in other regions. RNA-based testing provided more accurate data on active viremia, with viremic HDV prevalence rates ranging from 3.2% to 16%. Triple infection with HIV/HBV/HDV was associated with significantly lower CD4+ cell counts and worse clinical outcomes, including elevated liver enzymes and rapid progression to liver cancer. Key risk factors for HDV co-infection included multiple sexual partners, sharing of needles, and unsafe medical practices. Co-infected patients demonstrated worse clinical outcomes, such as elevated liver enzymes, decompensated cirrhos