Prevalence, correlates, and viral dynamics of hepatitis delta among injection drug users.
BACKGROUND
Most hepatitis delta virus (HDV) prevalence estimates from the United States are >10 years old, and HDV has shown significant temporal variation in other populations. HDV-hepatitis B virus (HBV) dual infection progresses rapidly, has more complications, and has a different treatment regimen than HBV infection alone. Accurate estimates of prevalence and risk factors are important to help clinicians decide who to screen.


METHODS
Injection drug users in Baltimore, Maryland, who were positive for HBV serologic markers were tested for hepatitis delta antibody (HDAb) at 2 time periods: 1988-1989 (194 participants) and 2005-2006 (258 participants). Those who were HDAb positive in 2005-2006, plus a random sample of HDAb negative, HBV-positive participants were tested for HDV RNA, HBV DNA, and HCV RNA. Characteristics associated with HDV exposure and viremia were identified.


RESULTS
HDV prevalence declined from 15% in 1988-1989 to 11% in 2005-2006. Among those with chronic HBV infection, prevalence increased from 29% (14 of 48 participants) to 50% (19 of 38 participants) (P=.05). Visiting a "shooting gallery" (a location where people gather to inject illegal drugs) was a strong correlate of HDAb positivity (relative risk, 3.08; P=.01). Eight (32%) of those who were HDAb positive had HDV viremia. Viremic participants had elevated liver enzyme levels and more emergency room visits.


CONCLUSIONS
The temporal increase in HDV prevalence among those with chronic HBV infection is troubling; understanding this change should be a priority to prevent the burden from increasing.
Kucirka
Lauren M
LM
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. lkucirka@jhsph.edu
Farzadegan
Homayoon
H
Feld
Jordan J
JJ
Mehta
Shruti H
SH
Winters
Mark
M
Glenn
Jeffrey S
JS
Kirk
Gregory D
GD
Segev
Dorry L
DL
Nelson
Kenrad E
KE
Marks
Morgan
M
Heller
Theo
T
Golub
Elizabeth T
ET
D000293:Adolescent; D000328:Adult; D000368:Aged; D015142:Baltimore / Q000453:epidemiology; D015897:Comorbidity; D004279:DNA, Viral / Q000097:blood; D055030:Drug Users; D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification; D006515:Hepatitis B virus / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000150:complications*; D003699:Hepatitis D / Q000453:epidemiology*; D003698:Hepatitis Delta Virus / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000150:complications*; D055815:Young Adult
D004279:DNA, Viral; D012367:RNA, Viral