Section of Hepatology, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
Section of Hepatology, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; Department of Medicine, Chelsea and Westminster Hospital, London, UK.
Lancet Gastroenterol Hepatol. 2022 Oct;7(10):932-942. doi: 10.1016/S2468-1253(22)00201-1. Epub 2022 Aug 10.
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.
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.
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).
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.
None.
尽管人们越来越关注乙型肝炎病毒（HBV）的传染性和临床影响，但隐匿性乙型肝炎病毒感染在乙型肝炎消除议程中却很少受到关注。我们旨在估计全球和区域范围内以及特定人群中隐匿性 HBV 感染的流行率。
本系统评价和荟萃分析检索了 MEDLINE、Embase、全球健康和 Web of Science 数据库中 2010 年 1 月 1 日至 2019 年 8 月 14 日发表的所有语言的文章。我们纳入了报告 HBsAg 阴性（年龄≥18 岁）成年人中 HBV DNA 阳性（即患有隐匿性 HBV 感染的人群）比例的原始文章和会议摘要。采用 DerSimonian-Laird 随机效应模型，对一般人群和按研究参与者类型（献血者；其他低危人群；高危人群；以及患有晚期慢性肝病的人群）定义的特定人群中的隐匿性 HBV 感染流行率进行汇总，并按每个国家的 HBV 流行程度进行分层。我们还评估了抗-HBc 作为替代生物标志物检测隐匿性 HBV 感染的性能。本研究已在 PROSPERO 上注册，注册号为 CRD42019115490。
从 3962 篇文章中筛选出 305 篇，对检测 HBV DNA 的 140521993 人进行了荟萃分析。总体而言，仅有两项研究评估了一般人群中的隐匿性 HBV 感染，因此无法对隐匿性 HBV 感染的全球和区域流行率进行无偏估计。在献血者中，隐匿性 HBV 感染的流行率与 HBV 流行程度一致：低流行国家为 0.06%（95%CI 0.00-0.26），中流行国家为 0.12%（0.04-0.23），高流行国家为 0.98%（0.44-1.72）（p=0.0012）。在高危人群中，无论流行程度如何，隐匿性 HBV 感染的流行率都很高：低流行国家为 5.5%（95%CI 2.9-8.7），中流行国家为 5.2%（2.5-8.6），高流行国家为 12.0%（3.4-24.7）。抗-HBc 检测隐匿性 HBV 感染的敏感性为 77%（95%CI 62-88），特异性为 76%（68-83）。
全球范围内，特别是在高危人群和高流行国家的人群中，相当一部分人携带隐匿性 HBV 感染。隐匿性 HBV 感染应成为全球病毒性肝炎消除战略的一部分。
无。
Zotero 插件
