Abstract
Background. Hepatitis D virus (HDV) infection has been considered a serious neglected pandemic, particularly in developing countries. The virus causes a more severe disease than mono infection with hepatitis B virus (HBV).The epidemiology of HDV is not well documented in North Africa, which is known to be endemic for HBV. In this study, we explored the prevalence of HDV infection and also attempted to identify factors associated with hepatitis D positive status among chronic hepatitis B patients in North Africa. Methods.The electronic databases PubMed, Embase, Scopus, Science Direct,Web of Science, and Google Scholar were comprehensively searched for all papers published between January 1, 1998, andDecember 31, 2017, using appropriate strategies containing all related keywords, including North Africa, names of countries in the region, and all permutations of hepatitis Dvirus. The estimated prevalence of HDV in North Africa was calculated as an average of the pooled infection prevalence in each country weighted by the ratio of the country’s hepatitis D virus population to the study’s sample size in the survey data analysis. Findings. A total of 312 studieswere identified and 32were included in this study,with a total sample of 4907 individuals screened forHDV.There was considerable variability in the prevalence estimates ofHDVwithin the countries of the region.The overall prevalence ofHDVin the general population ofNorthAfrica 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-1was themost prominent genotype reported in five published studies. Ten studies reported onHDVRNA in participants who were seropositive for HDV, and four studies highlighted the impact of demographic factors (sex and age).No study showed the impact of risk factors on the prevalence of HDV in North Africa. Interpretation.This review provides a comprehensive assessment of the burden of HDV in Northern Africa.There were significant differences in seroprevalence, study population, and diagnostic testing between the countries in the region. The results presented here will alert health professionals to implement clear policies based on evidence to diminish the burden of HDV infection. Such measures may include but are not restricted to improving the laboratory diagnostic tests and initiating patient data registries and blood screening. Further epidemiological and research studies are needed to explore the risk factors, coinfections, and approaches to increase testing for HDV, particularly in highrisk subpopulations, such as intravenous drug users and immigrants, and to define the consequences of HDV infection in North Africa.