Hepatitis D Virus Positivity among Patients from Liberia with Chronic Hepatitis B Virus Infection

Hepatitis D virus (HDV) infection in individuals with chronic hepatitis B virus (HBV) is associated with accelerated liver disease and hepatocellular carcinoma (HCC). In this retrospective cohort of 1,337 HBsAg-positive patients at an urban safety-net hospital in Minneapolis, Minnesota, 41.6% were tested for anti-HDV antibodies, of whom 8.8% were positive. Among those testing positive, 28% had polymerase chain reaction-confirmed HDV infection. HDV Ab-positive patients were predominantly of African descent (88%), with 71% being Liberian. In comparison with HDV Ab-negative patients, those with HDV had a higher prevalence of cirrhosis (34.7% versus 12.2%), HCC (6.1% versus 2.8%), HIV (14.3% versus 8.3%), Hepatitis C virus (HCV) (10.2% versus 1.0%), and alcohol use (36.7% versus 27.8%). HDV Ab-positivity was associated with higher rates of advanced fibrosis in comparison with HDV Ab-negative individuals (36.7% versus 15%). Despite the high prevalence among Liberian patients, only 50% of this group was screened for HDV. Black race (OR: 3.75; 95% CI: 1.46-9.61), cirrhosis (OR: 3.56; 95% CI: 1.47-8.60), aspartate aminotransferase ≥80 U/L (OR: 3.05; 95% CI: 1.05-8.89), and HBV DNA <2,000 IU/mL (OR: 3.36; 95% CI: 1.61-6.98) as independent predictors of HDV Ab positivity. These findings underscore significant missed opportunities with risk-based screening and support universal HDV screening for HBsAg-positive individuals to improve detection and outcome.