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Bazie MM, Sanou M, Djigma FW, Compaore TR, Obiri-Yeboah D, Kabamba B, Nagalo BM, Simpore J, Ouédraogo R. Genetic diversity and occult hepatitis B infection in Africa: A comprehensive review. World J Hepatol 2024; 16:843-859. [PMID: 38818293 PMCID: PMC11135261 DOI: 10.4254/wjh.v16.i5.843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/06/2024] [Accepted: 04/15/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Occult hepatitis B infection (OBI) is a globally prevalent infection, with its frequency being influenced by the prevalence of hepatitis B virus (HBV) infection in a particular geographic region, including Africa. OBI can be transmitted through blood transfusions and organ transplants and has been linked to the development of hepatocellular carcinoma (HCC). The associated HBV genotype influences the infection. AIM To highlight the genetic diversity and prevalence of OBI in Africa. METHODS This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and involved a comprehensive search on PubMed, Google Scholar, Science Direct, and African Journals Online for published studies on the prevalence and genetic diversity of OBI in Africa. RESULTS The synthesis included 83 articles, revealing that the prevalence of OBI varied between countries and population groups, with the highest prevalence being 90.9% in patients with hepatitis C virus infection and 38% in blood donors, indicating an increased risk of HBV transmission through blood transfusions. Cases of OBI reactivation have been reported following chemotherapy. Genotype D is the predominant, followed by genotypes A and E. CONCLUSION This review highlights the prevalence of OBI in Africa, which varies across countries and population groups. The study also demonstrates that genotype D is the most prevalent.
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Affiliation(s)
- Michee M Bazie
- Department of Medicine, Transmissible Diseases Laboratory, Université Joseph KI-ZERBO, Ouagadougou 0000, Burkina Faso
| | - Mahamoudou Sanou
- Department of Medicine, Transmissible Diseases Laboratory, Université Joseph KI-ZERBO, Ouagadougou 0000, Burkina Faso
| | - Florencia Wendkuuni Djigma
- Department of Biochemistry and Microbiology, Molecular Biology and Genetics Laboratory, University Joseph KI-ZERBO, Ouagadougou 0000, Burkina Faso.
| | - Tegwinde Rebeca Compaore
- Infectious and parasitic disease Laboratory, Health Sciences Research Institute, IRSS/CNRST, National Center for Scientific and Technological Research, Ouagadougou 0000, Burkina Faso
| | - Dorcas Obiri-Yeboah
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, PMB, Cape Coast 0000, Ghana
| | - Benoît Kabamba
- Department of Clinical Biology, Virology Laboratory, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Bruxelles 0000, Belgium
| | | | - Jacques Simpore
- Department of Biochemistry and Microbiology, Molecular Biology and Genetics Laboratory, University Joseph KI-ZERBO, Ouagadougou 0000, Burkina Faso
| | - Rasmata Ouédraogo
- Department of Medicine, Transmissible Diseases Laboratory, Université Joseph KI-ZERBO, Ouagadougou 0000, Burkina Faso
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Anderson M, Phinius BB, Phakedi BK, Mudanga M, Bhebhe LN, Tlhabano GN, Motshosi P, Ratsoma T, Baruti K, Mpebe G, Choga WT, Marlink R, Glebe D, Blackard JT, Moyo S, Kramvis A, Gaseitsiwe S. Persistence and risk factors of occult hepatitis B virus infections among antiretroviral therapy-naïve people living with HIV in Botswana. Front Microbiol 2024; 15:1342862. [PMID: 38784816 PMCID: PMC11112038 DOI: 10.3389/fmicb.2024.1342862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Aim This study aimed to determine the kinetics of occult hepatitis B virus infections (OBI) among people with HIV (PWH). Methods The study used archived plasma samples from longitudinal HIV natural history studies. We identified new OBI cases and assessed risk factors for OBI using Cox proportional hazards regression analysis. Results At baseline, 8 of 382 [(2.1%) (95% CI: 1.06-4.1)] samples tested positive for hepatitis B surface antigen (HBsAg+). Of the 374 HBsAg-negative samples, 76 had sufficient sample volume for HBV DNA screening. OBI positivity (OBI+) at baseline was reported in 11 of 76 [14.7 95% CI (8.3-24.1)] HBsAg-negative (HBsAg-) participants. Baseline HBsAg-negative samples with sufficient follow-up samples (n = 90) were used for analysis of newly identified OBI cases. Participants contributed 129.74 person-years to the study and were followed for a median of 1.02 years (IQR: 1.00-2.00). Cumulatively, there were 34 newly identified OBI cases from the 90 participants, at the rate of 26.2/100 person-years (95% CI: 18.7-36.7). Newly identified OBI cases were more common among men than women (61.1% vs. 31.9%) and among participants with CD4+ T-cell counts ≤450 cells/mL (p-value = 0.02). Most of the newly identified OBI cases [55.9% (19/34)] were possible reactivations as they were previously HBV core antibody positive. Conclusion There was a high rate of newly identified OBI among young PWH in Botswana, especially in men and in participants with lower CD4+ T-cell counts. OBI screening in PWH should be considered because of the risk of transmission, possible reactivation, and risk factors for the development of chronic liver disease, including hepatocellular carcinoma.
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Affiliation(s)
- Motswedi Anderson
- Research Laboratory, Botswana Harvard Health Partnership, Gaborone, Botswana
| | - Bonolo B. Phinius
- Research Laboratory, Botswana Harvard Health Partnership, Gaborone, Botswana
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | | | - Mbatshi Mudanga
- Botswana – University of Maryland School of Medicine Health Initiative, Gaborone, Botswana
| | - Lynnette N. Bhebhe
- Research Laboratory, Botswana Harvard Health Partnership, Gaborone, Botswana
| | - Girlie N. Tlhabano
- Research Laboratory, Botswana Harvard Health Partnership, Gaborone, Botswana
| | - Patience Motshosi
- Research Laboratory, Botswana Harvard Health Partnership, Gaborone, Botswana
| | - Tsholofelo Ratsoma
- Research Laboratory, Botswana Harvard Health Partnership, Gaborone, Botswana
| | - Kabo Baruti
- Research Laboratory, Botswana Harvard Health Partnership, Gaborone, Botswana
- Department of Biological Sciences, Faculty of Science, University of Botswana, Gaborone, Botswana
| | - Gorata Mpebe
- Research Laboratory, Botswana Harvard Health Partnership, Gaborone, Botswana
| | - Wonderful T. Choga
- Research Laboratory, Botswana Harvard Health Partnership, Gaborone, Botswana
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Richard Marlink
- Research Laboratory, Botswana Harvard Health Partnership, Gaborone, Botswana
- Rutgers Global Health Institute, Rutgers University, New Brunswick, NJ, United States
| | - Dieter Glebe
- Institute of Medical Virology, National Reference Centre for Hepatitis B Viruses and Hepatitis D Viruses, Justus Liebig University of Giessen, Giessen, Germany
| | - Jason T. Blackard
- Division of Digestive Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Sikhulile Moyo
- Research Laboratory, Botswana Harvard Health Partnership, Gaborone, Botswana
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Division of Medical Virology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Anna Kramvis
- Hepatitis Virus Diversity Research Unit, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Simani Gaseitsiwe
- Research Laboratory, Botswana Harvard Health Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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3
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Camara M, Tantuoyir MM, SeyedAlinaghi S, Ghiasvand F, Ahmadinejad Z. Prevalence of hepatitis B infection in the Gambian population: A narrative review of recent developments. Prev Med Rep 2023; 36:102401. [PMID: 37719791 PMCID: PMC10500481 DOI: 10.1016/j.pmedr.2023.102401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023] Open
Abstract
Hepatitis B is a "silent epidemic", fifty to a hundred (50-100) times more infectious than HIV, a potentially life-threatening liver infection caused by the hepatitis B virus (HBV). HBV can cause acute and chronic infection and subsequently results in a high risk of death from cirrhosis and liver cancer. Despite the availability of a safe and effective vaccine, HBV continues to be a global burden including in The Gambia. This study reviewed the recent trends in the epidemiological characteristics of HBV in the Gambia. The researchers conducted an online literature search for primary studies on HBV prevalence published in the past two decades from Jan 1992 to Feb 2022 inclusive on Google Scholar, PubMed, and Scopus. All retrieved studies were assessed for eligibility according to specific inclusion/exclusion criteria, data completeness, and methodological coherence. We found that HBV infection prevalence is above 8% in The Gambia. Moreover, HBV is the most common cause of hepatocellular carcinoma (HCC) in Gambia. Liver cirrhosis and HCC have the highest mortality contribution among hepatitis patients, with occult HBV carriers as major culprits. Also, vaccination coverage has declined from 91% to 88% according to reports from current literature. To achieve the WHO goal of eliminating HBV by 2030, policies targeting infection transmission control among risk groups, community awareness programs, research, price reduction of drugs, mass vaccinations, and diagnostics should be urgently instituted.
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Affiliation(s)
- Muhammed Camara
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Edward Francis Small Teaching Hospital, Banjul, the Gambia
| | - Marcarious M. Tantuoyir
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Ghiasvand
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Ahmadinejad
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Spearman CW. The burden of chronic liver disease in west Africa: a time for action. Lancet Glob Health 2023; 11:e1319-e1320. [PMID: 37517419 DOI: 10.1016/s2214-109x(23)00345-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Catherine Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, 7925, South Africa.
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Vincent JP, Ndow G, Ogawa S, Ceesay A, Njie R, Sanneh B, Baldeh I, D’Alessandro U, Mendy M, Thursz M, Chemin I, Tanaka Y, Lemoine M, Shimakawa Y. Mac-2 binding protein glycosylation isomer (M2BPGi) to evaluate liver fibrosis and cancer in HBV-infected patients in West Africa. J Glob Health 2022; 12:04076. [PMID: 36370422 PMCID: PMC9653177 DOI: 10.7189/jogh.12.04076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background To reduce mortality associated with hepatitis B virus (HBV) infection, timely detection of cirrhosis and early-stage hepatocellular carcinoma (HCC) is essential. In low-income countries, however, HBV-infected people have limited access to liver histopathology, a reference test. Recently, Asian studies have suggested the usefulness of an inexpensive serum biomarker called Mac-2 binding protein glycosylation isomer (M2BPGi) in staging liver fibrosis and predicting HCC in HBV-infected patients. Methods We systematically searched PubMed for studies examining the performance of M2BPGi in staging liver fibrosis in HBV-infected people, published up to September 21, 2021, to elucidate the knowledge gap. We then conducted a cross-sectional study of 339 HBV-infected patients in The Gambia (cirrhosis = 65, HCC = 73, non-cirrhosis non-HCC = 201). We evaluated the association of M2BPGi with cirrhosis and HCC by computing odds ratios (ORs) derived from logistic regression. We also assessed the performance of M2BPGi to stage liver fibrosis in 49 patients who underwent liver biopsy (derivation set) and 217 patients with transient elastography (validation set). Using the derivation set we drew the receiver operating characteristics (ROC) curves to identify optimal M2BPGi thresholds to indicate significant fibrosis and cirrhosis using biopsy as a reference. We then applied these cut-offs to the validation set to obtain its sensitivity and specificity for indicating significant fibrosis and cirrhosis using transient elastography as a reference. Results The systematic review identified 13 studies, all of which were conducted in East Asia and none in Africa. In The Gambia, positive M2BPGi was significantly associated with both cirrhosis (adjusted OR = 7.8, 95% CI = 3.1-19.7) and HCC (adjusted OR = 10.1, 2.6-40.2). The areas under the ROC curve (AUROC) in the derivation and validation set were 0.62 and 0.78, respectively, to diagnose significant fibrosis, and 0.80 and 0.89, respectively, to diagnose cirrhosis. By applying the optimal cut-offs, the sensitivity and specificity in the validation set were 61.5% and 93.4%, respectively, to diagnose significant fibrosis, and 72.5% and 92.2%, respectively, for cirrhosis. Conclusions To the best of our knowledge, this is the first evaluation of M2BPGi in HBV-infected African population. The findings supported its accuracy in the diagnosis of cirrhosis in HBV-infected patients in West Africa.
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Affiliation(s)
| | - Gibril Ndow
- Division of Digestive Diseases, Department of Metabolism, Digestion & Reproduction, Imperial College London, London, United Kingdom
- Disease Control & Elimination, MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Shintaro Ogawa
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Amie Ceesay
- Disease Control & Elimination, MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ramou Njie
- Edward Francis Small Teaching Hospital, Banjul, The Gambia
- School of Medicine & Allied Health Sciences, University of The Gambia, Serekunda, The Gambia
| | - Bakary Sanneh
- National Public Health Laboratories, Ministry of Health, Serekunda, The Gambia
| | - Ignatius Baldeh
- National Public Health Laboratories, Ministry of Health, Serekunda, The Gambia
| | - Umberto D’Alessandro
- Disease Control & Elimination, MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Maimuna Mendy
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Mark Thursz
- Division of Digestive Diseases, Department of Metabolism, Digestion & Reproduction, Imperial College London, London, United Kingdom
| | - Isabelle Chemin
- INSERM U1052, CNRS UMR5286, Centre de Recherche en Cancérologie, Université Claude Bernard, Lyon, France
| | - Yasuhito Tanaka
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Maud Lemoine
- Division of Digestive Diseases, Department of Metabolism, Digestion & Reproduction, Imperial College London, London, United Kingdom
| | - Yusuke Shimakawa
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
- International Research Center for Medical Sciences (IRCMS), Kumamoto University, Kumamoto, Japan
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Spearman CW, Dusheiko G, Jonas E, Abdo A, Afihene M, Cunha L, Desalegn H, Kassianides C, Katsidzira L, Kramvis A, Lam P, Lesi OA, Micah EA, Musabeyezu E, Ndow G, Nnabuchi CV, Ocama P, Okeke E, Rwegasha J, Shewaye AB, Some FF, Tzeuton C, Sonderup MW. Hepatocellular carcinoma: measures to improve the outlook in sub-Saharan Africa. Lancet Gastroenterol Hepatol 2022; 7:1036-1048. [PMID: 35810766 DOI: 10.1016/s2468-1253(22)00041-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/26/2022] [Accepted: 02/02/2022] [Indexed: 02/08/2023]
Abstract
Hepatocellular carcinoma is a leading public health concern in sub-Saharan Africa, and it is most prevalent in young adults (median 45 years [IQR 35-57]). Overall, outcomes are poor, with a median survival of 2·5 months after presentation. Major risk factors for hepatocellular carcinoma are hepatitis B virus (HBV), hepatitis C virus, aflatoxin B1 exposure, and alcohol consumption, with metabolic dysfunction-associated fatty liver disease slowly emerging as a risk factor over the past few years. Crucially, these risk factors are preventable and manageable with effective implementation of the HBV birth-dose vaccination, treatment of chronic viral hepatitis, provision of harm reduction services, and by decreasing aflatoxin B1 exposure and harmful alcohol consumption. Primary prevention is central to the management of hepatocellular carcinoma, especially in poorly resourced environments. Effective screening and surveillance programmes with recall policies need to be implemented, because detection and curative management of hepatocellular carcinoma is possible if it is detected at an early stage, even in countries with minimal resources, with appropriate upskilling of medical personnel. The establishment of centres of excellence with advanced diagnostic and therapeutic capabilities within countries should improve hepatocellular carcinoma outcomes and assist in driving the implementation of much needed systematic data systems focused on hepatocellular carcinoma to establish the accurate burden in sub-Saharan Africa. Such data would support the public health importance of hepatocellular carcinoma and provide a strong basis for advocacy, programme development, resource allocation, and monitoring of progress in reducing mortality.
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Affiliation(s)
- C Wendy Spearman
- Division of Hepatology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Geoffrey Dusheiko
- University College London Medical School, London, UK; Kings College Hospital, London, UK
| | - Eduard Jonas
- Surgical Gastroenterology Unit, Division of General Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Abdelmounem Abdo
- National Centre for Gastrointestinal and Liver Disease, Ibn Sina Hospital, Alamarat, Khartoum, Sudan
| | - Mary Afihene
- Department of Medicine, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lina Cunha
- Gastroenterology Unit, Maputo Private Hospital, Maputo, Mozambique
| | - Hailemichael Desalegn
- Department of Internal Medicine, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Chris Kassianides
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Leolin Katsidzira
- Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Anna Kramvis
- Hepatitis Virus Diversity Research Unit, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Olufunmilayo A Lesi
- Gastroenterology and Hepatology Unit, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Eileen A Micah
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Gibril Ndow
- Disease Control and Elimination Theme, MRC Unit The Gambia at the London School of Tropical Medicine, London, UK; Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Chidi V Nnabuchi
- Asokoro District Hospital, Nile University Teaching Hospital, Abuja, Nigeria
| | - Ponsiano Ocama
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Edith Okeke
- Gastroenterology and Hepatology Unit, Department of Internal Medicine, College of Health Sciences, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - John Rwegasha
- Gastroenterology Training Centre, Department of Internal Medicine, Muhimbili National Hospital, Dar Es Salaam, Tanzania
| | - Abate B Shewaye
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fatuma F Some
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Christian Tzeuton
- Faculty of Medicine and Pharmaceutical Sciences of Douala, University of Douala, Douala, Cameroon
| | - Mark W Sonderup
- Division of Hepatology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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7
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Im YR, Jagdish R, Leith D, Kim JU, Yoshida K, Majid A, Ge Y, Ndow G, Shimakawa Y, Lemoine M. Prevalence of occult hepatitis B virus infection in adults: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2022; 7:932-942. [PMID: 35961359 PMCID: PMC9630161 DOI: 10.1016/s2468-1253(22)00201-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 12/03/2022]
Abstract
Background Despite growing concerns about transmissibility and clinical impact, occult hepatitis B virus (HBV) infection has received little attention in the hepatitis elimination agenda. We aimed to estimate the prevalence of occult HBV infection at a global and regional scale and in specific populations. Methods For this systematic review and meta-analysis, we searched the MEDLINE, Embase, Global Health, and Web of Science databases for articles published in any language between Jan 1, 2010, and Aug 14, 2019. We included original articles and conference abstracts of any study design that reported the proportion of HBsAg-negative adults (aged ≥18 years) who are positive for HBV DNA (ie, people with occult HBV infection). The prevalence of occult HBV infection was pooled, using the DerSimonian-Laird random-effects model, in the general population and specific groups defined by the type of study participants (blood donors; other low-risk populations; high-risk populations; and people with advanced chronic liver disease), and stratified by HBV endemicity in each country. We also assessed the performance of anti-HBc as an alternative biomarker to detect occult HBV infection. The study was registered with PROSPERO, CRD42019115490. Findings 305 of 3962 articles were eligible, allowing a meta-analysis of 140 521 993 individuals tested for HBV DNA. Overall, only two studies evaluated occult HBV infection in the general population, precluding unbiased global and regional estimates of occult HBV infection prevalence. In blood donors, occult HBV infection prevalence mirrored HBV endemicity: 0·06% (95% CI 0·00–0·26) in low-endemicity countries, 0·12% (0·04–0·23) in intermediate-endemicity countries, and 0·98% (0·44–1·72), in high-endemicity countries (p=0·0012). In high-risk groups, occult HBV infection prevalence was substantial, irrespective of endemicity: 5·5% (95% CI 2·9–8·7) in low-endemicity countries, 5·2% (2·5–8·6) in intermediate-endemicity countries, and 12·0% (3·4–24·7) in high-endemicity countries. The pooled sensitivity of anti-HBc to identify occult HBV infection was 77% (95% CI 62–88) and its specificity was 76% (68–83). Interpretation A substantial proportion of people carry occult HBV infection, especially among high-risk groups across the globe and people living in highly endemic countries. Occult HBV infection should be part of the global viral hepatitis elimination strategy. Funding None.
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