Hepatitis delta virus infection in a large cohort of chronic hepatitis B patients in Ethiopia

Liver Int. 2018 Jun;38(6):1000-1009. doi: 10.1111/liv.13607. Epub 2017 Oct 20.


Background & aims: Hepatitis D virus (HDV) infection is associated with a more severe outcome in patients with chronic hepatitis B (CHB); however, little is known about the presence of HDV in sub-Saharan Africa. We aimed to determine the prevalence of HDV infection, as well as its clinical, biological and virological characteristics, in a large CHB cohort in Ethiopia.

Methods: In total, 1267 HIV-negative CHB patients at St. Paul's Hospital Millennium Medical College in Addis Ababa were screened for anti-HDV antibodies using ELISA assays. Confirmed positive samples were further tested for HDV RNA using a consensus commercial real-time RT-PCR assay. HDV genotypes were also determined for RNA-positive samples by nucleotide sequencing followed by phylogenetic analyses. Demographical, clinical and biological data from patients were recorded and compared based on HDV RNA results.

Results: Most patients (n = 748, 59.0%) were men, and the median age was 31 years (interquartile range 26-40). Anti-HDV antibodies were detected in 19 individuals (1.5%), 12 of whom were HDV RNA-positive with a viral load ranging from <2 to >8 log 10 IU/mL. All strains were genotype 1. HDV RNA-positive patients were more likely to have significant liver fibrosis (63.6% vs 24.7%, P = .007) and cirrhosis (45.5% vs 16.4%, P = .024).

Conclusions: HDV infection is rare in Ethiopia but is associated with more advanced liver fibrosis.

Trial registration: ClinicalTrials.gov NCT02344498.

Keywords: HDV genotype; hepatitis delta virus; liver fibrosis; molecular assays; serology; sub-Saharan Africa.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Cohort Studies
  • Coinfection / mortality
  • Coinfection / virology*
  • Enzyme-Linked Immunosorbent Assay
  • Ethiopia / epidemiology
  • Female
  • Hepatitis Antibodies / blood
  • Hepatitis B, Chronic / complications*
  • Hepatitis D / epidemiology*
  • Hepatitis D / mortality
  • Hepatitis Delta Virus / genetics*
  • Humans
  • Liver Cirrhosis / virology*
  • Logistic Models
  • Male
  • Middle Aged
  • Phylogeny
  • Real-Time Polymerase Chain Reaction
  • Viral Load
  • Young Adult


  • Hepatitis Antibodies

Associated data

  • ClinicalTrials.gov/NCT02344498