Aim: This study aimed to determine the seroprevalence and viremic infection of hepatitis delta virus (HDV) in Kermanshah.
Background: Hepatitis delta is one of the most complex viral infections of liver that along with hepatitis B virus could lead to fulminant
hepatitis, progressive chronic hepatitis, cirrhosis, and hepatocellular carcinoma.
Methods: Referrals with positive HBs Ag were included and tested for HDV Ab using ELISA. Seropositives were subsequently
evaluated for viremia by assaying HDV RNA and HBV DNA using real-time PCR. Viremia-related variables were also assessed.
Results: From 1749 patients included, 30 had positive HDV Ab, which makes HDV seroprevalence 1.7%. Twenty-nine out of 30
seropositives were assayed for viremia. Fourteen cases (48.3%) had positive HDV PCR, 18 (62.1%) had positive HBV DNA. Eight
patients (27.6%) had simultaneous replication of HBV and HDV, six (20.7%) only had HDV replication, ten (34.5%) only had HBV
replication and five (17.2%) had no replication of either viruses.
Conclusion: Kermanshah seems to be a low prevalent area in Middle East. Viremic HDV infection was lower compared to Europe and
Africa, probably due to genetic variations of the hosts or the differences in genotypes or sub-types of hepatitis B and D viruses.
Keywords: Hepatitis D, Prevalence, Viremia, Iran.
(Please cite as: Sayad B, Naderi Y, Alavian SM, Najafi F, Janbakhsh A, Mansouri F, et al. Hepatitis D virus infection
in Kermanshah, west of Iran: seroprevalence and viremic infections. Gastroenterol Hepatol Bed Bench
Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet (London, England) 2015; 386(10003): 1546-55.
Noureddin M, Gish R. Hepatitis delta: epidemiology, diagnosis and management 36 years after discovery. Curr Gastroenterol Rep 2014; 16(1): 365.
Amini N, Alavian SM, Kabir A, Saiedi Hosseini SY, Aalaei Andabili SH. Clinical Features and Seroepidemiology of Anti-HDV Antibody in patients With Chronic Hepatitis B Virus Infection in Iran: A Meta-Analysis. Hepat Mon 2011; 11(12): 960-7.
Ott JJ, Stevens GA, Groeger J, Wiersma ST. Global epidemiology of hepatitis B virus infection: new estimates of age-specific HBsAg seroprevalence and endemicity. Vaccine 2012; 30(12): 2212-9.
Manesis EK, Vourli G, Dalekos G, Vasiliadis T, Manolaki N, Hounta A, et al. Prevalence and clinical course of hepatitis delta infection in Greece: a 13-year prospective study. J Hepatol 2013; 59(5): 949-56. 6. Rizzetto M, Alavian SM. Hepatitis delta: the rediscovery. Clin Liver Dis 2013; 17(3): 475-87.
Taghvaei T, Khanlarpoor M, Mahdavi MR, Tirgar Fakheri H, Maleki E, Khalilian AR. Prevalence of positive Hepatitis Delta Virus in patients with positive Hepatitis B surface Antigen and its correlative factors in Sari. Journal of Mazandaran University of Medical Sciences 2008; 18(67): 102-6.
Mohammad Alizadeh AH, Ranjbar M, Tehrani AS, Keramat F, Mamani M, Rezazadeh M, et al. Seroprevalence of hepatitis D virus and its risk factors in the west of Iran. Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 2010; 43(6): 519-23.
Motamedifar M, Taheri M, Lankarani KB, Gholami M, Lari MA, Faramarzi H, et al. The Prevalence and Risk Factors of Hepatitis Delta Virus in HIV/HBV Co-Infected Patients in Shiraz, Iran, 2012. Iran J Med Sci 2015; 40(5): 448-53.
Vaziri S, Mansouri F, Sayad B, Afsharian M, Janbakhsh A, Karami M. Hepatitis D virus infection among HIV-HBV co-infected patients in Kermanshah, West of Iran. Hepatitis Monthly 2008; 8(4).
Hassanjani Roshan M, Baiki A, Soleimani M. Prevalence of anti HDV in HBV carriers in Babol during 2000-02. Journal of Babol University Of Medical Sciences 2004; 6(1): 50-4.
Ghadir MR, Belbasi M, Heidari A, Sarkeshikian SS, Kabiri A, Ghanooni AH, et al. Prevalence of hepatitis d virus infection among hepatitis B virus infected patients in qom province, center of iran. Hepat Mon 2012; 12(3): 205-8.
Amini S, Mahmoodi MF, Andalibi S, Solati AA. Seroepidemiology of hepatitis B, delta and human immunodeficiency virus infections in Hamadan province, Iran: a population based study. J Trop Med Hyg 1993; 96(5): 277-87.
Ataei B, Yazdani MR, Kalantari H, Yaran M, Nokhodian Z, Javadi AA, et al. Hepatitis D virus infection in Isfahan, central Iran: Prevalence and risk factors among chronic HBV infection cases. Hepat Mon 2011; 11(4): 269-72.
Ziaee M, Azarkar G. Prevalence of hepatitis d virus infection among patients with chronic hepatitis B attending birjand hepatitis clinic (East of iran) in 2012. Hepat Mon 2013; 13(8): e11168.
Roshandel G, Semnani S, Abdolahi N, Besharat S, Kashtkar AA, Joshaghani HR, et al. The prevalence of Co-infection with HCV and HDV in HBV infected patients in Golestan province of Iran. Journal of Gorgan University of Medical Sciences 2008; 9(4): 61-5.
Torabi SE, Ebrahimpour S, Maljaee SH, Naghili B. eroepidemiology of Hepatitis Delta Virus in HBsAg Positive Patients in Tabriz. MJTUOMS 2002; 4: 290-7.
Habibi F, Motavaselian AH. Evaluation of the hepatitis B antibody(Anti HBs) level fallowing of vaccination among medical students in Islamic Azad university (Mashhad branch) in 2013. Scientific Journal Management System 2013; 3(1): 1-10.
Eskandar H, SeyedJalal H, Fariba J. Seroprevalence of delta hepatitis in patients with chronic hepatitis B and its clinical impact in Khuzestan province, southwest Iran. Hepatitis Monthly 2009; 2009(4, Autumn): 287-92.
Bakhshipour A, Mashhadi M, Mohammadi M, Nezam SK. Seroprevalence and risk factors of hepatitis delta virus in chronic hepatitis B virus infection in Zahedan. Acta Med Iran 2013; 51(4): 260-4. 21. Attaran MS, Sharifi Z, Hosseini SM, Samei S, Ataee Z. Prevalence of hepatitis B and hepatitis D coinfection in asymptomatic blood donors in Iran. Apmis 2014; 122(3): 243-7.
Kasraian L, Tavassoli A, Shayegan M, Alavian SM. The prevalence and risk factor of hepatitis B and D in Shiraz blood donors. African Journal of Microbiology Research 2012; 6(18): 3976-9.
Tajbakhsh E, Tajbakhsh S, Yaghobi R, Momeni M, Tajbakhsh F, Hamedi S. Serological survey of HDV-Ab in HBsAg positive blood donors in Shahrekord, Iran. African Journal of Microbiology Research 2011; 5(10): 1243-5.
Shah L. Prevalence of hepatitis D virus (HDV) in south Gujarat. Natl J Med Res 2012; 2(2): 117-20
Zaidi G, Idrees M, Malik FA, Amin I, Shahid M, Younas S, et al. Prevalence of hepatitis delta virus infection among hepatitis B virus surface antigen positive patients circulating in the largest province of Pakistan. Virol J 2010; 7: 283.
Abbasi A, Bhutto AR, Butt N, Mahmood K. HDV seroprevalence in HBsAg positive patients. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP 2014; 24(9): 624-7.
Hussein NR, Rasheed ZA, Taha AA, Shaikhow SK. The prevalence of hepatitis D Virus infection amongst patients with Chronic active hepatitis B Virus infection in Duhok Governorate. International Journal of Pure and Applied Sciences and Technology 2015; 28(1): 1.
Amini N, Alavian SM, Kabir A, Aalaei-Andabili SH, Saiedi Hosseini SY, Rizzetto M. Prevalence of hepatitis d in the eastern mediterranean region: systematic review and meta analysis. Hepat Mon 2013; 13(1): e8210.
Al-Traif I, Ali A, Dafalla M, Al-Tamimi W, Qassem L. Prevalence of hepatitis delta antibody among HBsAG carriers in Saudi Arabia. Ann Saudi Med 2004; 24(5): 343-4.
Al-Kandari S, Nordenfelt E, Al-Nakib B, Hansson BG, Ljunggren K, Al-Nakib W. Hepatitis delta virus infection in acute hepatitis in Kuwait. Scand J Infect Dis 1988; 20(1): 15-9.
Kim HS, Kim SJ, Park HW, Shin WG, Kim KH, Lee JH, et al. Prevalence and clinical significance of hepatitis D virus co-infection in patients with chronic hepatitis B in Korea. J Med Virol 2011; 83(7): 1172-7.
El Guneid AM, Gunaid AA, O'Neill AM, Zureikat NI, Coleman JC, Murray-Lyon IM. Prevalence of hepatitis B, C, and D virus markers in Yemeni patients with chronic liver disease. J Med Virol 1993; 40(4): 330-3.
Degertekin H, Yalcin K, Yakut M, Yurdaydin C. Seropositivity for delta hepatitis in patients with chronic hepatitis B and liver cirrhosis in Turkey: a meta-analysis. Liver international : official journal of the International Association for the Study of the Liver 2008; 28(4): 494-8.
Kose S, Ece G, Gozaydin A, Turken M. Study on seroprevalence of hepatitis delta in a regional hospital in western Turkey. Journal of infection in developing countries 2012; 6(11): 782-5.
Ho E, Deltenre P, Nkuize M, Delwaide J, Colle I, Michielsen P. Coinfection of hepatitis B and hepatitis delta virus in Belgium: a multicenter BASL study. Prospective epidemiology and comparison with HBV mono-infection. J Med Virol 2013; 85(9): 1513-7.
Gheorghe L, Csiki IE, Iacob S, Gheorghe C, Trifan A, Grigorescu M, et al. Hepatitis Delta Virus Infection in Romania: Prevalence and Risk Factors. Journal of gastrointestinal and liver diseases : JGLD 2015; 24(4): 413-21.
Popescu GA, Otelea D, Gavriliu LC, Neaga E, Popescu C, Paraschiv S, et al. Epidemiology of hepatitis D in patients infected with hepatitis B virus in bucharest: a cross-sectional study. J Med Virol 2013; 85(5): 769-74.
Sagnelli E, Stroffolini T, Ascione A, Bonino F, Chiaramonte M, Colombo M, et al. The epidemiology of hepatitis delta infection in Italy. Promoting Group. J Hepatol 1992; 15(1-2): 211-5.
Gomaa NI, Metwally LA, Nemr N, Younis S. Seroprevalence of HDV infection in HBsAg positive population in Ismailia, Egypt. Egypt J Immunol 2013; 20(1): 23-8.
Lunel-Fabiani F, Mansour W, Amar AO, Aye M, Le Gal F, Malick FZ, et al. Impact of hepatitis B and delta virus co-infection on liver disease in Mauritania: a cross sectional study. The Journal of infection 2013; 67(5): 448-57.
Mendes-Correa MC, Gomes-Gouvea MS, Alvarado-Mora MV, Da Silva MH, Lazari C, Cavalcanti NC, et al. Hepatitis delta in HIV/HBV co-infected patients in Brazil: is it important? International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 2011; 15(12): e828-32.
Niro GA, Smedile A, Ippolito AM, Ciancio A, Fontana R, Olivero A, et al. Outcome of chronic delta hepatitis in Italy: a long-term cohort study. J Hepatol 2010; 53(5): 834-40
Williams V, Brichler S, Radjef N, Lebon P, Goffard A, Hober D, et al. Hepatitis delta virus proteins repress hepatitis B virus enhancers and activate the alpha/beta interferon-inducible MxA gene. The Journal of general virology 2009; 90(Pt 11): 2759-67
Buti M, Homs M, Rodriguez-Frias F, Funalleras G, Jardi R, Sauleda S, et al. Clinical outcome of acute and chronic hepatitis delta over time: a long-term follow-up study. J Viral Hepat 2011; 18(6): 434-42.
Blumberg BS. Sex differences in response to hepatitis B virus. I. History. Arthritis and rheumatism 1979; 22(11): 1261-6.
London WT, Drew JS. Sex differences in response to hepatitis B infection among patients receiving chronic dialysis treatment. Proceedings of the National Academy of Sciences of the United States of America 1977; 74(6): 2561-3.
Gardner ID. The effect of aging on susceptibility to infection. Reviews of infectious diseases 1980; 2(5): 801-10.
Jacobson IM, Dienstag JL, Werner BG, Brettler DB, Levine PH, Mushahwar IK. Epidemiology and clinical impact of hepatitis D virus (delta) infection. Hepatology 1985; 5(2): 188-91.
Keshvari M, Alavian SM, Aghaee B, Behnava B, Mahdavi M, Fesharaki MG, et al. Seroepidemiology and clinical features of hepatitis delta among HBsAg carriers: a study from Hepatitis Clinic of Iranian Blood Transfusion Organization. Transfusion medicine (Oxford, England) 2014; 24(6): 411-7.
Romeo R, Del Ninno E, Rumi M, Russo A, Sangiovanni A, de Franchis R, et al. A 28-year study of the course of hepatitis Delta infection: a risk factor for cirrhosis and hepatocellular carcinoma. Gastroenterology 2009; 136(5): 1629-38.
Heidrich B, Serrano BC, Idilman R, Kabacam G, Bremer B, Raupach R, et al. HBeAg-positive hepatitis delta: virological patterns and clinical long-term outcome. Liver international : official journal of the International Association for the Study of the Liver 2012; 32(9): 1415-25.