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.

中文翻译：

---

成人隐匿性乙型肝炎病毒感染的患病率：系统评价和荟萃分析

背景

尽管人们越来越担心传染性和临床影响，但隐匿性乙型肝炎病毒 (HBV) 感染在消除肝炎的议程中很少受到关注。我们旨在评估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。

方法

对于本次系统评价和荟萃分析，我们在 MEDLINE、Embase、Global Health 和 Web of Science 数据库中搜索了 2010 年 1 月 1 日至 2019 年 8 月 14 日期间以任何语言发表的文章。我们包括原始文章和会议摘要任何报告 HBsAg 阴性成人（≥18 岁）HBV DNA 阳性（即隐匿性 HBV 感染者）比例的研究设计。使用 DerSimonian-Laird 随机效应模型汇总了一般人群和由研究参与者类型（献血者；其他低风险人群；高风险人群；以及人群）定义的特定人群中隐匿性 HBV 感染的流行率。晚期慢性肝病），并根据每个国家的 HBV 流行情况进行分层。我们还评估了抗 HBc 作为检测隐匿性 HBV 感染的替代生物标志物的性能。该研究在 PROSPERO 注册，CRD42019115490。

发现

3962 篇文章中有 305 篇符合条件，允许对 140 521 993 人进行 HBV DNA 检测的荟萃分析。总体而言，只有两项研究评估了普通人群的隐匿性 HBV 感染，排除了对隐匿性 HBV 感染流行率的无偏见的全球和区域估计。在献血者中，隐匿性 HBV 感染率反映了 HBV 流行性：低流行国家为 0·06% (95% CI 0·00–0·26)，中度流行性国家为 0·12% (0·04–0·23)高流行国家中为 0·98% (0·44–1·72) (p=0·0012)。在高危人群中，隐匿性 HBV 感染率很高，无论是否流行：低流行国家为 5·5% (95% CI 2·9-8·7)，5·2% (2·5-8· 6）在中度流行国家，12·0%（3·4-24·7）在高流行国家。

解释

很大一部分人携带隐匿性 HBV 感染，尤其是在全球高危人群和生活在高度流行国家的人群中。隐匿性 HBV 感染应成为全球病毒性肝炎消除战略的一部分。

资金

没有任何。