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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

1
Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
2
Department of Medicine and Infection Control, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
3
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
4
Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
5
Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
6
Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
7
Department of Medicine, Medical College of National Cheng Kung University, Tainan, Taiwan.
8
Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
9
Section of Infectious Diseases, Taipei City Hospital, Taipei City Government, Taipei, Taiwan.
10
Department of General Surgery, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
11
Translational Research Division, Medical Research Department, Taipei Veterans General Hospital, Taipei, Taiwan.

Abstract

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).

CONCLUSION:

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.

PMID:
25677884
DOI:
10.1002/hep.27742
[Indexed for MEDLINE]

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