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Hepatitis D virus: is it all in the family?
  1. Anders Boyd1,2,
  2. Gilles Wandeler3,4
  1. 1 Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands
  2. 2 Stichting HIV Monitoring, Amsterdam, The Netherlands
  3. 3 Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
  4. 4 Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
  1. Correspondence to Dr Gilles Wandeler, Department of Infectious Diseases, Bern University Hospital, 3010 Bern, Switzerland; gilles.wandeler{at}

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Hepatitis delta virus (HDV) infection is the most severe form of chronic viral hepatitis: HDV-infected individuals are more likely to die from advanced liver disease compared with hepatitis B virus (HBV)-infected without HDV and their risk of developing hepatocellular carcinoma is up to nine times higher.1 HDV is a defective virus, using the HBV surface antigen to enter hepatocytes. Pegylated interferon-alfa is currently the only recommended therapy for HDV infection, although treatment success remains unacceptably low. The recent development of novel treatments, including the entry inhibitor bulevirtide, may improve treatment outcomes. Thus, understanding the epidemiology of HDV is crucial for planning and implementing efficient testing and management strategies.

According to a recent meta-analysis, HDV infection, as determined by the presence of anti-HDV antibodies, affects 7% of HBV-infected persons in sub-Saharan Africa (SSA), with a pooled prevalence reaching 26% of general hepatitis B surface antigen (HBsAg)-positive individuals in Central Africa.2 Therefore, in specific regions, chronic HDV infection may well be an important barrier to the WHO’s HBV elimination objectives, including the significant reduction of HBV-related mortality.3 However, our knowledge of the epidemiological determinants of HDV infection has remained insufficient, especially in high endemic regions of SSA. The study by Besombes et al 4 published in Gut is a welcome addition to the …

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  • Contributors AB and GW wrote the manuscript.

  • Funding AB has received grants from the French National Agency for Research on AIDS and Viral Hepatitis (ANRS) and Sidaction. GW is supported by a Professorship from the Swiss National Science Foundation [PP00P3_176944].

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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