The epidemiology and clinical outcome of hepatitis D virus (delta) infection in Jordan

Authors

  • Ala U. Toukan F.A.C.P.,

    Corresponding author
    1. Liver Unit, Departments of Medicine and Pathology, Jordan University Hospital, Faculty of Medicine, Jordan University, Amman, Jordan
    2. Hepatitis Branch, Division of Viral Diseases, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia 30333
    • P.O. Box 13046, Jordan University Hospital, Amman, Jordan
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  • Omayma A. Abu-El-Rub,

    1. Liver Unit, Departments of Medicine and Pathology, Jordan University Hospital, Faculty of Medicine, Jordan University, Amman, Jordan
    2. Hepatitis Branch, Division of Viral Diseases, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia 30333
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  • Salwa A. Abu-Laban,

    1. Liver Unit, Departments of Medicine and Pathology, Jordan University Hospital, Faculty of Medicine, Jordan University, Amman, Jordan
    2. Hepatitis Branch, Division of Viral Diseases, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia 30333
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  • Musleh S. Tarawneh,

    1. Liver Unit, Departments of Medicine and Pathology, Jordan University Hospital, Faculty of Medicine, Jordan University, Amman, Jordan
    2. Hepatitis Branch, Division of Viral Diseases, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia 30333
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  • M. Feisal Kamal,

    1. Liver Unit, Departments of Medicine and Pathology, Jordan University Hospital, Faculty of Medicine, Jordan University, Amman, Jordan
    2. Hepatitis Branch, Division of Viral Diseases, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia 30333
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  • Stephen C. Hadler,

    1. Liver Unit, Departments of Medicine and Pathology, Jordan University Hospital, Faculty of Medicine, Jordan University, Amman, Jordan
    2. Hepatitis Branch, Division of Viral Diseases, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia 30333
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  • Krzysztof Krawczynski,

    1. Liver Unit, Departments of Medicine and Pathology, Jordan University Hospital, Faculty of Medicine, Jordan University, Amman, Jordan
    2. Hepatitis Branch, Division of Viral Diseases, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia 30333
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  • Harold S. Margolis,

    1. Liver Unit, Departments of Medicine and Pathology, Jordan University Hospital, Faculty of Medicine, Jordan University, Amman, Jordan
    2. Hepatitis Branch, Division of Viral Diseases, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia 30333
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  • James E. Maynard

    1. Liver Unit, Departments of Medicine and Pathology, Jordan University Hospital, Faculty of Medicine, Jordan University, Amman, Jordan
    2. Hepatitis Branch, Division of Viral Diseases, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia 30333
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Abstract

The epidemiology and clinical outcome of hepatitis D viral infection in HBsAg-positive acute hepatitis, chronic liver disease, primary hepatocellular carcinoma and the symptomless carrier state was studied in Jordan. The prevalence of hepatitis D viral infection was significantly higher in patients with chronic liver disease (18/79, 23%) and acute hepatitis (17/108, 16%) than in symptomless HBsAg carriers (2/136, 2%). The highest prevalence of hepatitis D viral infection was found in patients with primary hepatocellular carcinoma (10/15, 67%) who were also significantly older than such patients without hepatitis D viral infection. Antihepatitis D virus IgM was detected persistently in 83% of patients with antihepatitis D virus-positive chronic liver disease and transiently in 41% of patients with acute hepatitis. A trend to increased mortality was observed in acute hepatitis D viral superinfection (25%) compared to hepatitis D viral coinfection (0%) and to antihepatitis D virus-negative HBsAg-positive acute hepatitis (4%). In patients with established chronic liver disease, however, neither survival nor histological parameters of disease activity were significantly different in the antihepatitis D virus-positive and antihepatitis D virus-negative groups. While the early stage of hepatitis D viral super-infection is associated with increased mortality, it appears that in patients with late-stage chronic liver disease, severe histological activity subsides, and survival is no longer influenced by the factor of hepatitis D viral infection. However, primary hepatocellular carcinoma appears to complicate the course of those antihepatitis D virus-positive patients surviving beyond this stage.

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