Seroprevalence of Delta Hepatitis in Patients with Chronic Hepatitis B and its Clinical Impact in Khuzestan Province, Southwest Iran

Hepatitis B virus (HBV) and hepatitis D virus (HDV) infections are major health problems in Iran. Preliminary reports indicate that HDV infection, a satellite virus of HBV, exists in this area. However, its prevalence in patients with different types of liver diseases has not been studied in detail. This study was carried out to determine the seroprevalence of HDV among individuals who tested positive for hepatitis B surface antigen (HBsAg) in a southwestern province of Iran. In this cross-sectional study a total of 1,725 consecutive patients with HBV liver diseases attending the Ahwaz JundiShapur University Hospitals (AJSUH) and Hepatitis Clinics from 2002 to 2008 were included. We performed tests for HBV and HDV serum markers, using commercially available enzyme-linked immunosorbent assay kits. Patients were split into two groups according to their HDV antibody (anti-HDV) status (HDV positive or negative). The collected data were coded, and the statistical analyses were conducted. The mean age of the patients was 37 ± 13/8 years. There were 1,157 males and 568 females. Of the 1,725 patients with HBV liver disease, 150 were found to be reactive for anti-delta antibodies, yielding an overall HDV seroprevalence of 11.5%. Anti-HDV was found in 3.59% of patients with inactive chronic hepatitis, 45.5% of patients with chronic active hepatitis, and 43.2% of cirrhotic and hepatocellular carcinoma patients (P < 0.001). A higher proportion of individuals testing positive for antibodies to HDV were observed among males (72%) than among females (28%). The patients without HDV infection were younger than anti-HDV-positive/HBsAg-positive patients (P < 0.01). HDV infection was common in patients with HBV in our community. All HBV patients should be screened for HDV infection. The results indicate that HDV co-infection was related to the severity of the liver disease. More studies designed to elucidate HDV''s epidemiology are needed.