title: Prevalence, correlates, and viral dynamics of hepatitis delta among injection drug users.
abstract: 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.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. lkucirka@jhsph.edu
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Kucirka
authors.forename: Homayoon
authors.initials: H
authors.lastname: Farzadegan
authors.forename: Jordan J
authors.initials: JJ
authors.lastname: Feld
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
authors.forename: Mark
authors.initials: M
authors.lastname: Winters
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Glenn
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Kirk
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
authors.forename: Kenrad E
authors.initials: KE
authors.lastname: Nelson
authors.forename: Morgan
authors.initials: M
authors.lastname: Marks
authors.forename: Theo
authors.initials: T
authors.lastname: Heller
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Golub
mesh_terms: 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
chemical_list: D004279:DNA, Viral; D012367:RNA, Viral