Clinical Impact and Frequency of Hepatitis D Virus Infection in HBsAg Positive Patients in a Southern Province of Iran (Kerman)

Background and Aims: Hepatitis D virus (HDV) can infect human population either as a superinfection or concurrent hepatitis B virus (HBV) infection. It is expected that presence of HDV infection is more prevalent in endemic HBV areas. Overall 5% of Iranian general populations are chronic HBV carriers. The aim of this study was to determine the seroprevalence of HDV and its clinical impact in a local area of southern Iran (Kerman province). Methods: The study carried out during 2006-2007 on all hepatitis B surface antigens (HBsAg) positive subjects who referred to the main referral hospital (Afzalipour Academic Health Center) and subspecialty GI offices in the city of Kerman. The study included just stable chronic hepatitis B and inactive HBV carriers around the province. High risk group subjects and other concurrent hepatitis viral infections were excluded. Results: One hundred and ninety six patients were enrolled in the study. They consist of 143 (73%) men, 53 (27%) women, with a mean age of 39.2 ± 7.1 (range 20-60) years.  Twenty-one subjects (10.7%) were positive for anti HDV antibody (Ab). Male to female ratio was 6/1 in this group. All of the HDV positive cases acquired the infection as a super-infection.  Elevated aminotransferases (ALT- AST) was documented in 81% of HDV positive cases and in 41% of HDV negative subjects (p=0.001). Conclusion: HDV investigation is recommended in HBV infected patients, particularly those with elevated liver enzymes in a relatively high prevalent area as in Iran.