title: Epidemiology and clinical pattern of hepatitis delta virus infection in Pakistan.
abstract: OBJECTIVE
  The global epidemiology of hepatitis delta virus (HDV) infection is changing. This study was performed to determine the epidemiology and clinical impact of hepatitis delta in Pakistan.
  
  
  METHODS
  Countrywide data was collected from 1994 to 2001. A total of 8721 patients were tested for hepatitis delta antibody. A subset of 97 hepatitis delta antibody reactive inpatients with chronic liver disease were compared to 97 patients admitted with liver disease due to hepatitis B alone.
  
  
  RESULTS
  Of the 8721 patients tested, 1444 (16.6%) were reactive for hepatitis delta antibody. Most were males (87.4%, P < 0.001) and younger (mean age 31 years, P < 0.001) compared to HDV non-reactive patients. Prevalence of delta infection was highest in the rural (range 25-60%) compared to the urban population (range 6.5-11%). Analysis of the inpatient data showed that delta infected patients had significantly less severe clinical liver disease and a trend towards lesser development of hepatocellular carcinoma compared to delta negative patients.
  
  
  CONCLUSIONS
  (i) HDV infection is present in 16.6% of hepatitis B infected patients in Pakistan, most commonly in younger males living in rural areas; and (ii) delta virus infected patients have less severe clinical liver disease compared to delta negative, hepatitis B patients.
authors.affiliation: Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Khalid
authors.initials: K
authors.lastname: Mumtaz
authors.forename: Saeed S
authors.initials: SS
authors.lastname: Hamid
authors.forename: Salman
authors.initials: S
authors.lastname: Adil
authors.forename: Asim
authors.initials: A
authors.lastname: Afaq
authors.forename: M
authors.initials: M
authors.lastname: Islam
authors.forename: Shahab
authors.initials: S
authors.lastname: Abid
authors.forename: Hasnain A
authors.initials: HA
authors.lastname: Shah
authors.forename: Wasim
authors.initials: W
authors.lastname: Jafri
mesh_terms: D000293:Adolescent; D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000821:virology; D005260:Female; D006508:Hepatitis Antibodies / Q000097:blood; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D003699:Hepatitis D / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology* / Q000821:virology; D003698:Hepatitis Delta Virus / Q000276:immunology; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000453:epidemiology / Q000821:virology; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data; D016036:Seroepidemiologic Studies; D012720:Severity of Illness Index; D014505:Urban Population / Q000706:statistics & numerical data
chemical_list: D006508:Hepatitis Antibodies