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Prevalence And Clinical Course Of Hepatitis Delta Infection In Gree A 13-Year Prospective Study

Prevalence And Clinical Course Of Hepatitis Delta Infection In Gree A 13-Year Prospective Study

Hepatitis D virus (HDV) has decreased in Europe, but recent reports indicate a rising trend. We report the epidemiological changes, clinical progress and effect of treatment on the natural course of HDV-infection in Greece during the last 13 years. Prospective data, extracted from the HepNet.Greece Cohort-Study. Since 1997, 4673 chronic HBV (CHB) cases (4527 adults, 146 children) have been followed prospectively. Two-thousand-one-hundred-thirty-seven patients were tested for anti-HDV [101 (4.7%) positive]. Anti-HDV testing in Greece decreased significantly (57.0% before 2003, 35.3% thereafter; P<0.001). Anti-HDV prevalence among HBsAg-positives was 4.2%; lower in native-Greeks (2.8%) than in immigrants (7.5%) or in children (15.3%; P<0.001). Within 2.3-years follow-up, HDV occurred in 11/2047 HBsAg-positive patients (2.2 new delta-infected adults and 8.7 children per 1000 HBsAg-positive annually). HDV-positive compared to CHB adults were younger (P=0.035) and had more active and advanced disease at baseline, as indicated by laboratory indices and the higher prevalence of cirrhosis at younger age. During 4.2 years median observation, significantly more anti-HDV-positive than CHB adults developed a liver-related first event (20.0% vs. 8.5%, Plog-rank=0.014).Treatment received by 46/90 (51.1%) patients, 40 of them interferon-based. In multivariable analysis, interferon significantly decreased disease progression in HDV-positive patients [HR=0.14 (95%CI: 0.02-0.86; P=0.033)]. In Greece, HDV-serology is currently tested in only one-third of HBsAg-positive patients. HDV prevalence is lower in native-Greeks compared to immigrants, who may contribute >50% of HDV infection burden in Greece. Data show that HDV infection is a rapidly progressive disease, but interferon-based treatment may alter its course.

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