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Hepatology. 2015 Jun;61(6):1870-9. doi: 10.1002/hep.27742. Epub 2015 Apr 20.

Changing hepatitis D virus epidemiology in a hepatitis B virus endemic area with a national vaccination program.

Lin HH1,2, Lee SS3,4, Yu ML5, Chang TT6,7, Su CW1,3,8, Hu BS9, Chen YS10, Huang CK2, Lai CH2, Lin JN2, Wu JC1,11.

Author information

Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
Department of Medicine and Infection Control, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
Department of Medicine, Medical College of National Cheng Kung University, Tainan, Taiwan.
Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Section of Infectious Diseases, Taipei City Hospital, Taipei City Government, Taipei, Taiwan.
Department of General Surgery, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
Translational Research Division, Medical Research Department, Taipei Veterans General Hospital, Taipei, Taiwan.


The emergence of hepatitis D virus (HDV) infection in the era of widespread HBV vaccination has not been described before. We aimed to investigate the changing epidemiology of HDV infection among high- and low-risk populations after an outbreak of human immunodeficiency virus (HIV) infection among injection drug users (IDUs) in Taiwan. A prospective, multicenter, cohort study of 2,562 hepatitis B surface antigen (HBsAg)-positive individuals was conducted to determine the prevalence, genotype, and risk factors of HDV infection from 2001 through 2012. The prevalence rates of HDV infection were 74.9%, 43.9%, 11.4%, 11.1%, and 4.4% among HIV-infected IDUs, HIV-uninfected IDUs, HIV-infected men who have sex with men, HIV-infected heterosexuals, and the general population of HBsAg-positive subjects, respectively. A significant increase in the trend of HDV prevalence from 38.5% to 89.8% was observed in HIV-infected IDUs (odds ratio = 3.06; 95% confidence interval: 1.68-5.56; P = 0.0002). In multivariate analysis, injection drug use, hepatitis C virus infection, HIV infection, serum HBsAg level ≧250 IU/mL, duration of drug use, and older age were significant factors associated with HDV infection. HDV genotype IV (72.2%) was the prevalent genotype circulating among IDUs, whereas genotype II was predominant in the non-IDU populations (73.3%). In the HIV cohort born after 1987 who were HBsAg negative, over half (52.9%) had antibody to hepatitis B surface antigen antibody levels of <10 mIU/mL and there was a significantly higher HBsAg seroprevalence in the HIV cohort, compared to the control group (8.1% vs. 0.0%; P = 0.02).


In the era of HBV vaccination, IDUs and HIV-infected individuals have emerged as high-risk groups and a reservoir for HDV infection. Effective strategies are needed to curb the reemerging epidemic of HDV infection in these high-risk groups.

[Indexed for MEDLINE]

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