TY - JOUR T1 - Hepatitis D virus: is it all in the family? JF - Gut JO - Gut DO - 10.1136/gutjnl-2019-320549 SP - gutjnl-2019-320549 AU - Anders Boyd AU - Gilles Wandeler Y1 - 2020/02/14 UR - http://gut.bmj.com/content/early/2020/02/13/gutjnl-2019-320549.abstract N2 - 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 al4 published in Gut is a welcome addition to the … ER -