title: Coinfection with hepatitis B and D: epidemiology, prevalence and disease in patients in Northern California.
abstract: OBJECTIVE
  With no report on the overall prevalence and ramifications of hepatitis Delta virus (HDV) infection in the United States for more than two decades, the characteristics of chronic hepatitis B virus (CHB) patients coinfected with HDV, including clinical presentation, rate of hepatitis C virus tri-infection, and HDV viral load, were assessed.
  
  
  METHODS
  At California Pacific Medical Center, a retrospective chart review was conducted on all CHB patients.
  
  
  RESULTS
  Of 1191 CHB patients, 499 had been tested for HDV, with 42 (8%) determined to be coinfected; half of these were also hepatitis C virus-infected. Cirrhosis was present in 73% of the coinfected, 80% of the tri-infected, but only 22% of the monoinfected. Twenty-nine patients (69%) were Caucasian non-Hispanic; 10 (24%) were Asians and Pacific Islanders. Of 39 patients for whom HBV-DNA quantification at time of HDV presentation was available, 22 (56%) had undetectable levels; four (10%) had levels > 100 000 IU/mL.
  
  
  CONCLUSIONS
  HDV affects individuals of all ages and various ethnic groups. Although HBV viral loads are lower, rates of cirrhosis are higher in coinfected patients and higher still in the tri-infected. Our data support revising screening guidelines to advocate for all patients with HBV to be screened for HDV in order to both give the individual patient important information related to the possible need for treatment and to support the public health goal of reducing transmission by educating HDV-negative patients about the need for protection against superinfection and HDV-infected patients about the need to protect against transmission to others.
authors.affiliation: Section of Hepatology, Division of GI, Department of Medicine, University of California, San Diego, San Diego, California, USA; Center for Hepatobiliary Disease and Abdominal Transplantation, University of California, San Diego, San Diego, California, USA.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Gish
authors.forename: Debbie Hana
authors.initials: DH
authors.lastname: Yi
authors.forename: Steve
authors.initials: S
authors.lastname: Kane
authors.forename: Margaret
authors.initials: M
authors.lastname: Clark
authors.forename: Michael
authors.initials: M
authors.lastname: Mangahas
authors.forename: Sumbella
authors.initials: S
authors.lastname: Baqai
authors.forename: Mark A
authors.initials: MA
authors.lastname: Winters
authors.forename: James
authors.initials: J
authors.lastname: Proudfoot
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Glenn
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D060085:Coinfection / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006515:Hepatitis B virus / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D019701:Hepatitis D, Chronic / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D003698:Hepatitis Delta Virus / Q000302:isolation & purification; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000821:virology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D019562:Viral Load
chemical_list: D004279:DNA, Viral
keywords: chronic hepatitis B; chronic hepatitis C; cirrhosis; coinfection; hepatitis delta virus