title: Increasing incidence of recent hepatitis D virus infection in HIV-infected patients in an area hyperendemic for hepatitis B virus infection.
abstract: BACKGROUND
  Superinfection with hepatitis D virus (HDV) may increase the risk for hepatitis flares and chronic hepatic complications in patients with chronic hepatitis B virus (HBV) infection. This retrospective observational study aimed to examine the incidence of and factors associated with recent HDV superinfection among individuals coinfected with human immunodeficiency virus (HIV) and HBV.
  
  
  METHODS
  Anti-HDV immunoglobulin G (IgG) was sequentially determined in 375 HIV/HBV-coinfected patients to estimate the HDV incidence between 1992 and 2012. Plasma HDV and HBV loads and HBV surface antigen (HBsAg) levels were determined for the HDV seroconverters. A nested case-control study was conducted to identify the associated factors with HDV seroconversion. Phylogenetic analysis was performed using HDV sequences amplified from HDV seroconverters and HDV-seropositive patients at baseline.
  
  
  RESULTS
  During 1762.4 person-years of follow-up [PYFU], 16 patients seroconverted for HDV, with an overall incidence rate of 9.07 per 1000 PYFU, which increased from 0 in 1992-2001, to 3.91 in 2002-2006, to 13.26 per 1000 PYFU in 2007-2012 (P < .05). Recent HDV infection was associated with elevated aminotransferase and bilirubin levels and elevated rapid plasma reagin titers. Of the 12 patients with HDV viremia, 2 were infected with genotype 2 and 10 with genotype 4. HBsAg levels remained elevated despite a significant decline of plasma HBV DNA load with combination antiretroviral therapy that contained lamivudine and/or tenofovir.
  
  
  CONCLUSIONS
  Our findings show that the incidence of recent HDV infection in HIV/HBV-coinfected patients increased significantly from 1992-2001 to 2007-2011, and was associated with hepatitis flares and syphilis.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei.
authors.forename: Chien-Ching
authors.initials: CC
authors.lastname: Hung
authors.forename: Shih-Min
authors.initials: SM
authors.lastname: Wu
authors.forename: Pi-Han
authors.initials: PH
authors.lastname: Lin
authors.forename: Wang-Huei
authors.initials: WH
authors.lastname: Sheng
authors.forename: Zong-Yu
authors.initials: ZY
authors.lastname: Yang
authors.forename: Hsin-Yun
authors.initials: HY
authors.lastname: Sun
authors.forename: Mao-Song
authors.initials: MS
authors.lastname: Tsai
authors.forename: Kuan-Yeh
authors.initials: KY
authors.lastname: Lee
authors.forename: Ming-Siang
authors.initials: MS
authors.lastname: Huang
authors.forename: Shu-Fang
authors.initials: SF
authors.lastname: Chang
authors.forename: Yi-Ching
authors.initials: YC
authors.lastname: Su
authors.forename: Wen-Chun
authors.initials: WC
authors.lastname: Liu
authors.forename: Sui-Yuan
authors.initials: SY
authors.lastname: Chang
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D004279:DNA, Viral / Q000302:isolation & purification; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006508:Hepatitis Antibodies / Q000097:blood; D006515:Hepatitis B virus / Q000276:immunology / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000150:complications*; D003699:Hepatitis D / Q000453:epidemiology*; D003698:Hepatitis Delta Virus / Q000145:classification / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D010802:Phylogeny; D010949:Plasma / Q000821:virology; D012367:RNA, Viral / Q000235:genetics / Q000302:isolation & purification; D012189:Retrospective Studies; D012307:Risk Factors; D017422:Sequence Analysis, DNA; D019562:Viral Load
chemical_list: D004279:DNA, Viral; D006508:Hepatitis Antibodies; D012367:RNA, Viral
keywords: case-control study; seroconversion; seroincidence; sexually transmitted diseases; syphilis