title: High prevalence of chronic hepatitis D virus infection in Eastern Turkey: urbanization of the disease.
abstract: BACKGROUND
  Both hepatitis B virus (HBV) and hepatitis D virus (HDV) infection play an increasingly important role in liver diseases. The main objective of this study was to investigate the socio-epidemiological, laboratory and radiological aspects of both HBV and HDV infection near the Iranian border of Turkey.
  
  
  METHODS
  The study included 3352 patients with HBV and HDV infection. Socioepidemiological, laboratory and radiological aspects of the study subjects were retrospectively examined. Comorbid metabolic diseases were not assessed due to the retrospective design of the study.
  
  
  RESULTS
  Most of the study subjects were HBe antigen negative. No significant difference in terms of HBV-DNA levels or HBe antigen seropositivity was detected between the city centre and rural areas (p > 0.005). The mean HBV-DNA level in the anti-HDV-positive group was significantly lower than in the anti-HDV-negative group (p < 0.001). The rate of HDV-RNA positivity in women was higher than in their male counterparts (p = 0.017). Anti-HDV-IgG was detected in 18.4% of tested subjects who came from an urban area. In contrast, 12.5% of subjects of the rural group had a positive result for anti-HDV-IgG. Among 134 ultrasonographically evaluated delta hepatitis patients, 37.3% had liver cirrhosis. On the other hand, in 1244 patients with hepatitis B monoinfection, there were 90 patients with liver cirrhosis. Radiologically, the rate of hepatic steatosis in delta hepatitis patients was lower than in those with HBV monoinfection.
  
  
  CONCLUSIONS
  Hepatitis D virus infection was particularly prevalent among the urban population as well as in female subjects. More broadly, the current observations are the first to suggest an inverse correlation between delta hepatitis and ultrasonography-proven hepatic steatosis.
authors.affiliation: Department of Gastroenterology, School of Medicine, Yuzuncu Yil University, Van, Turkey.
authors.forename: Ahmet Cumhur
authors.initials: AC
authors.lastname: Dulger
authors.affiliation: Department of Gastroenterology, School of Medicine, Yuzuncu Yil University, Van, Turkey.
authors.forename: Burak
authors.initials: B
authors.lastname: Suvak
authors.affiliation: Department of Emergency Medicine, School of Medicine, Yuzuncu Yil University, Van, Turkey.
authors.forename: Hayriye
authors.initials: H
authors.lastname: Gonullu
authors.affiliation: Department of Anesthesiology, Van Region Training and Research Hospital, Van, Turkey.
authors.forename: Edip
authors.initials: E
authors.lastname: Gonullu
authors.affiliation: Department of Microbiology, School of Medicine, Bezmialem Vakıf University, Istanbul, Turkey.
authors.forename: Bilge
authors.initials: B
authors.lastname: Gultepe
authors.affiliation: Department of Gastroenterology, School of Medicine, Yuzuncu Yil University, Van, Turkey.
authors.forename: İbrahim
authors.initials: İ
authors.lastname: Aydın
authors.affiliation: Department of Radiology, School of Medicine, Yuzuncu Yil University, Van, Turkey.
authors.forename: Abdüssamet
authors.initials: A
authors.lastname: Batur
authors.affiliation: Department of Emergency Medicine, School of Medicine, Yuzuncu Yil University, Van, Turkey.
authors.forename: Sevdegul
authors.initials: S
authors.lastname: Karadas
authors.affiliation: Department of Gastroenterology, School of Medicine, Yuzuncu Yil University, Van, Turkey.
authors.forename: Şehmus
authors.initials: Ş
authors.lastname: Olmez
keywords: hepatitis B virus; hepatitis D virus; hepatosteatosis