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Hepatitis Delta Virus Infection in Romania: Prevalence and Risk Factors

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Liana Gheorghe1, Irma Eva Csiki2, Speranta Iacob1, Cristian Gheorghe1, Anca Trifan3, Mircea Grigorescu4, Adriana Motoc5, Andra Suceveanu6, Manuela Curescu7, Florin Caruntu8, Ioan Sporea9, Ciprian Brisc10, Ion Rogoveanu11, Razvan Cerban1, Letitia Tugui1, Andrea Alexandrescu12

1) Center Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute;
2) National Institute of Public Health, Bucharest;
3) Center Gastroenterology and Hepatology, Iasi;
4) Institute Gastroenterology and Hepatology Cluj Napoca;
5) Victor Babes Universitary Hospital of Infectious & Tropical Diseases, Bucharest;
6) Clinic Gastroenterology and Hepatology, University of Medicine and Pharmacy, Constanta;
7) University Hospital Infectious Diseases, Timisoara;
8) National Institute Infectious Diseases Matei Bals, Bucharest;
9) Center Gastroenterology and Hepatology, University of Medicine and Pharmacy, Timisoara;
10) Clinic Gastroenterology Hepatology, Oradea;
11) Clinic Gastroenterology Hepatology, University of Medicine and Pharmacy, Craiova;
12) Hoffmann La Roche, Bucharest, Romania

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.244.dtv

Background: Hepatitis delta virus (HDV) infection is associated with accelerated progression of fibrosis, early occurrence of hepatic decompensation and an increased risk for hepatocellular carcinoma. Epidemiological data on hepatitis delta virus (HDV) in Romania are still lacking. Aim: To assess the prevalence, virological, clinical and epidemiological features of HDV infection in Romanian patients.

Methods: We conducted a multicenter study in 10 centers. Data on sociodemographic characteristics and potential risk factors were collected through a questionnaire. Virological markers of HBV and HDV infection, biochemical and clinical features of liver disease were evaluated.

Results: The study population comprised 2,761 HBsAg(+) patients with a mean age of 43.8±13.8 years, out of whom 5.2% were HBeAg(+) and 55.7% were males. Liver cirrhosis was detected in 17.9% of patients, while 80.4% had chronic hepatitis. The prevalence of IgG anti-HDV(+) patients was 23.1%, out of whom 16.4% were HDV RNA positive. The highest prevalence of HDV infection was encountered in patients aged 50-59 years (28.9%) and patients aged ≥60 (24.8%) (p=0.0001). Seroprevalence of HDV was significantly higher in AgHBs(+) cirrhotics vs. noncirrhotics (43.4% vs 19.0%, p=0.0001). Risk factors for HDV infection were: occupational hazard, no HCV chronic infection, lack of anti-HBV vaccination, presence of blood transfusions, any previous surgery, frequent hospitalization or endoscopies, tattoos, body piercing, use of glass syringes, number of female sexual partners.

Conclusions: HBsAg(+) population in Romania is characterized by a high prevalence of HBeAg(-) HBV infection as well as HDV co-infection. A cohort phenomenon for HDV prevalence is also observed similar to that of HCV/HBV monoinfections.

Key words: hepatitis D (delta) virus – chronic hepatitis – prevalence – risk factors.