Time for universal screening for hepatitis D? A study describing screening patterns, characteristics and outcomes of hepatitis D virus infection

determine effect estimates and 95%CI weighted by study size for blood donors, low-risk populations, high-risk populations due to increased HBV exposure risk, and patients with advanced liver disease.We also assessed the effects of study design, HBV serology, HBV endemicity and presence of advanced liver disease on OBI prevalence.Results: Our meta-analysis included 400 studies and 143, 980, 492 individuals.Amongst anti-HBc-positive individuals (n = 7, 863), OBI prevalence was 7. 9% (5.3-10.8) in blood samples (n = 7, 345) and 55.2% (42.9-67.3) in liver samples (n = 367).Amongst anti-HBcnegative individuals (n = 45, 853), OBI prevalence was 1.1% (0.6-1.8) in blood samples (n = 44, 637) and 17.9% (5.1-35.2) in liver samples (n = 302).When assessing studies that included all individuals negative for HBsAg regardless of anti-HBc status and tested OBI in the blood, OBI prevalence was lowest in blood donors (0.2% [0.2-0.4]),followed by low-risk populations (2.5% [1.0-4.5]),high-risk populations due to increased HBV exposure risk (6.4% [4.2-9.0]) and patients with advanced liver disease (15.8% [8.1-25.2]).Endemicity of the country of study was predictive of OBI prevalence in blood donors.The presence of advanced liver disease was associated with an increased prevalence of OBI across case-control studies of patients with cirrhosis or HCC compared to healthy controls ( p < 0.001).Conclusion: OBI is common, clinically significant, and underestimated.Our study reports a consistently high prevalence of OBI in HBV-endemic areas and, globally, across high-risk groups.Screening of blood products with both nucleic acid testing (NAT) and anti-HBc might be necessary to eradicate this reservoir of HBV infection globally.OBI should no longer be overlooked in regional and global hepatitis B screening, prevention, and elimination programmes.