title: Retrospective analysis of chronic hepatitis D in a West German University Clinic over two decades: migratory pattern, prevalence and clinical outcome.
abstract: OBJECTIVE
  Epidemiology, clinical features and long term-course of chronic hepatitis D were addressed in a non-endemic Central European area.
  
  
  METHODS
  Sixty-seven patients with chronic hepatitis D were identified among 1307 HBsAg carriers at the university hospital Düsseldorf during two decades (1989 - 2008) and followed for a mean of 7 +/- 6 years. Forty-one of these were treated with IFN-alfa for at least six months.
  
  
  RESULTS
  Hepatitis D prevalence increased from 4.1 to 6.2 % among HBsAg carriers during the two decades (p < 0.06). Patients originating from the former Soviet Union (32.1 vs. 46.2 %) and Africa (0 vs. 17.9 %) became more frequent whereas the prevalence of patients from Southern Europe declined (46.5 vs.17.9 % p < 0.03). The time span between the diagnosis of hepatitis B and D was 4.8 +/- 7 years (p < 0.0001). A sustained virological response to interferon-alfa was achieved in 19.5 % of the patients. The yearly incidence rates for death, HCC and complications were 3.2 %, 2.7 % and 8 % among patients with liver cirrhosis. Estimated survival and complication-free survival during 12 years were 72 % and 45 % in cirrhotic compared to 100 % in non-cirrhotic patients (p < 0.008 and p < 0.0001, respectively).
  
  
  CONCLUSIONS
  Hepatitis D in western Germany appears to be on the increase and has a migration background that should be considered in clinical practice. Clinical outcome and response to IFN are as poor as in endemic regions, indicating the need to improve early diagnosis.
authors.affiliation: Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum der Heinrich-Heine-Universität Düsseldorf. erhardt@med.uni-duesseldorf.de
authors.forename: A
authors.initials: A
authors.lastname: Erhardt
authors.forename: M
authors.initials: M
authors.lastname: Hoernke
authors.forename: U
authors.initials: U
authors.lastname: Heinzel-Pleines
authors.forename: A
authors.initials: A
authors.lastname: Sagir
authors.forename: T
authors.initials: T
authors.lastname: Göbel
authors.forename: D
authors.initials: D
authors.lastname: Häussinger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D021821:Communicable Diseases, Emerging / Q000401:mortality*; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D019701:Hepatitis D, Chronic / Q000401:mortality*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D012189:Retrospective Studies; D013333:Student Health Services / Q000706:statistics & numerical data*; D016019:Survival Analysis; D015996:Survival Rate; D055815:Young Adult