Epidemiology and Natural History
Heiner Wedemeyer
Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
Search for more papers by this authorSvenja Hardtke
Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
Search for more papers by this authorMichael P. Manns
Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
Search for more papers by this authorHeiner Wedemeyer
Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
Search for more papers by this authorSvenja Hardtke
Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
Search for more papers by this authorMichael P. Manns
Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
Search for more papers by this authorHoward C. Thomas BSc, PhD, FRCP, FRCPath, FMedSci
Emeritus Professor of Hepatology, Department of Medicine, Imperial College London, London, UK
Search for more papers by this authorAnna S.F. Lok MD
Alice Lohrman Andrews Research Professor in Hepatology, Director of Clinical Hepatology, Professor of Internal Medicine, Associate Chair for Clinical Research, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
Search for more papers by this authorStephen A. Locarnini MBBS, BSc(Hons), PhD, FRCPath
Head, Research & Molecular Development, Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia
Search for more papers by this authorArie J. Zuckerman MD, DSc, FRCP, FRCPath, FMedSci
Emeritus Professor of Medical Microbiology, Formerly Principal and Dean, Royal Free Hospital School of Medicine
Search for more papers by this authorSummary
Hepatitis D virus (HDV) is the most severe form of viral hepatitis. Superinfection of HBsAg carriers with HDV results in chronic evolution of the infection in the vast majority of cases. In contrast, simultaneous co-infection with HBV and HDV frequently leads to severe acute hepatitis and may progress to acute liver failure. Anti-HDV-positive patients have an increased risk to experience liver-related morbidity and mortality. HDV may show complex and dynamic patterns of viral dominance. In most cases, HDV is dominant with high HDVRNA levels and suppressed HBVDNA. HDV is also dominant in triple-infected anti-HCV-positive patients where most subjects test HCVRNA–negative. HDV is highly prevalent in Central Asia, eastern Turkey, some African countries, and the Amazon Basin. In Western countries, HDV can frequently be detected in migrant populations and intravenous drug users. Vaccination against HBV needs to be applied to risk populations to prevent further spreading of HDV infection.
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