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Hepatitis D Infection in Asia: A Perspective From an Endemic Region

Chronic hepatitis delta (CHD) is caused by hepatitis delta virus (HDV), which is the smallest virus infecting mammals. It is estimated that approximately 5% of patients with chronic hepatitis B (CHB) virus are coinfected with HDV; therefore, between 15 and 20 million people live with CHD, with different prevalences depending on the region. Recent epidemiological metaanalysis studies showed that the global seroprevalence of HDV is approximately 0.8% to 1%, and approximately 10% to 13% of hepatitis B surface antigen (HBsAg)positive individuals have HDV coinfection. This prevalence is probably higher than the estimate. HDV has eight genotypes. HDV genotype 1 has a wide distribution, genotypes 2 and 4 are found predominantly in Asia, genotype 3 is localized to the Amazon Basin, and genotypes 5 to 8 are in Africa. In Turkey, nearly all patients with HDV are infected with genotype 1, which has been associated with more severe disease.