Histological and Serological Epidemiology of Hepatitis Delta Virus Coinfection among Patients with Chronic Active Hepatitis B Virus in Razavi Khorasan Province, Northeastern Iran
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Abstract
Background: Hepatitis delta virus (HDV), as well as hepatitis B virus (HBV), are regarded as one of the main public health issues in developing countries. This retrospective study described histological and serological features of HDV coinfection patients with chronic active HBV in Northeastern Iran.
Methods: The frequency of HDV seropositivity and its impact on serum liver enzyme levels and pathological features were investigated by reviewing clinical and laboratory data. This study contained chronic active HBV-infected patients having admitted the department during 2009 and 2014.
Results: The rate of HDV coinfection in chronic active carriers was 21.84%, with a male predominance. HDV seropositive carriers showed significantly higher concentrations of liver enzyme than chronic active HBV monoinfection. Moreover, there was a strong association between degrees of inflammation with HDV-positive patients’ enzyme levels.
Conclusion: The HDV seroprevalence in northeastern Iran was higher than that reported from elsewhere in Iran while comparable to some regions in Middle East, which, in turn, requires more comprehensive tools for diagnosing and screening the blood.
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2. Liaw YF, Fabien Z (2015). Hepatitis B Virus in Human Diseases. Humana Press, New York.
3. Dandri M, Locarnini S (2012). New insight in the pathobiology of hepatitis B virus infection. Gut, 61 1:i6-17.
4. Hughes SA, Wedemeyer H, Harrison PM (2011). Hepatitis delta virus. Lancet, 378 (9785):73-85.
5. Rizzetto M (2015). Hepatitis D Virus: Introduction and Epidemiology. Cold Spring Harb Perspect Med, 5 (7):a021576.
6. Kao JH (2002). Hepatitis B viral genotypes: clinical relevance and molecular characteristics. J Gastroenterol Hepatol, 17 (6):643-50.
7. Poorolajal J, Majdzadeh R (2009). Prevalence of chronic hepatitis B infection in Iran: a review article. J Res Med Sci, 14 (4):249-58.
8. Lozano R, Naghavi M, Foreman K et al (2012). Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 380 (9859):2095-128.
9. Hadziyannis SJ, Papaioannou C, Alexopoulou A (1991). The role of the hepatitis delta virus in acute hepatitis and in chronic liver disease in Greece. Prog Clin Biol Res, 364:51-62.
10. Romeo R, Foglieni B, Casazza G et al (2014). High serum levels of HDV RNA are predictors of cirrhosis and liver cancer in patients with chronic hepatitis delta. PLoS One, 9 (3):e92062.
11. Abbas Z, Afzal R (2013). Life cycle and pathogenesis of hepatitis D virus: A review. World J Hepatol, 5 (12):666-75.
12. Pascarella S, Negro F (2011). Hepatitis D virus: an update. Liver Int, 31 (1):7-21.
13. Romeo R, Del Ninno E, Rumi M et al (2009). A 28-year study of the course of hepatitis Delta infection: a risk factor for cirrhosis and hepatocellular carcinoma. Gastroenterology, 136 (5):1629-38.
14. Alavian SM, Assari SH, Manzoori-Joybari H et al (2005). [Frequency and risk factors of hepatitis D virus in hepatitis B patients]. Govaresh, 10 (1):21-6.
15. Gholamreza R, Shahryar S, Abbasali K et al (2007). Seroprevalence of hepatitis B virus and its co-infection with hepatitis D virus and hepatitis C virus in Iranian adult population. Indian J Med Sci, 61 (5):263-8.
16. Rezvan H, Forouzandeh B, Taroyan S, Fadaiee S, Azordegan F (1990). A study on delta virus infection and its clinical impact in Iran. Infection, 18 (1):26-8.
17. Amini-Kafiabad S, Taghinia A, Khanbaba F, A. T (2004). [The prevalence of Delta agent super-infection and coinfection among HBsAg-positive patients referring to reference IBTO Lab]. Hakim Health Syst Res J, 9 (4):7-11.
18. Taghavi S-A, Sedighi S, Mehrabani D, Khademolhosseini F (2008). Hepatitis D in chronic active hepatitis B: prevalence, liver enzyme levels and histopathology-an epidemiological study in Shiraz, southern Iran, 2003-2004. Hepat Mon, 8 (4):248-51.
19. .Lefkowitch JH (2007). Liver biopsy assessment in chronic hepatitis. Arch Med Res, 38 (6):634-43.
20. Mohammad-Alizadeh AH, Ranjbar M, Tehrani AS et al (2010). Seroprevalence of hepatitis D virus and its risk factors in the west of Iran. J Microbiol Immunol Infect, 43 (6):519-23.
21. Al-Hilli HA, Al-Ugaidy YH (2002). Prevalence of hepatitis delta virus super infection in chronic HBV infection. IJGE, 1 (3):30-33.
22. Celen MK, Ayaz C, Hosoglu S, Geyik MF, Ulug M (2006). Anti-hepatitis delta virus seroprevalence and risk factors in patients with hepatitis B in Southeast Turkey. Saudi Med J, 27 (5):617-20.
23. Hussein NR, Rasheed ZA, Taha AA, Shaikhow SK (2015). The prevalence of hepatitis D Virus infection amongst patients with Chronic active hepatitis B Virus infection in Duhok Governorate. Int J Pure Appl Sci Technol, 28 (1):1-7.
24. Bakhshipour A, Mashhadi M, Mohammadi M, Nezam SK (2013). Seroprevalence and risk factors of hepatitis delta virus in chronic hepatitis B virus infection in Zahedan. Acta Med Iran, 51 (4):260-4.
25. Amini S, Mahmoodi MF, Andalibi S, Solati AA (1993). Seroepidemiology of hepatitis B, delta and human immunodeficiency virus infections in Hamadan province, Iran: a population based study. J Trop Med Hyg, 96 (5):277-87.
26. Ghamari S, Alavian SM, Rizzetto M et al (2013). Prevalence of hepatitis delta virus (HDV) infection in chronic hepatitis B patients with unusual clinical pictures. Hepat Mon, 13 (8):e6731.
27. Foupouapouognigni Y, Noah DN, Sartre MT, Njouom R (2011). High prevalence and predominance of hepatitis delta virus genotype 1 infection in Cameroon. J Clin Microbiol, 49 (3):1162-4.
28. Nwokediuko SC, Ijeoma U (2009). Seroprevalence of antibody to HDV in Nigerians with hepatitis B virus-related liver diseases. Niger J Clin Pract, 12 (4):439-42.
29. Acharya SK, Madan K, Dattagupta S, Panda SK (2006). Viral hepatitis in India. Natl Med J India, 19 (4):203-17.
30. Louisirirotchanakul S, Myint KS, Srimee B et al (2002). The prevalence of viral hepatitis among the Hmong people of northern Thailand. Southeast Asian J Trop Med Public Health, 33 (4):837-44.
31. Zaki H, Darmstadt GL, Baten A, Ahsan CR, Saha SK (2003). Seroepidemiology of hepatitis B and delta virus infections in Bangladesh. J Trop Pediatr, 49 (6):371-4.
32. Ghadir MR, Belbasi M, Heidari A et al (2012). Prevalence of hepatitis d virus infection among hepatitis B virus infected patients in qom province, center of iran. Hepat Mon, 12 (3):205-8.
33. Hassanjani Roshan M, Baiki A, Soleimani M (2002). [Prevalence of anti-HDV in chronic carrier of HBV in Babol]. J Babol Univ Med Sci, 6:50-54.
34. Zahedi M (2003). [Serologic Prevalence of Hepatitis D in HBsAg Positive Patients in Kerman, South of Iran, 2002-2003]. Kerman Univ Med Sci Health Serv, Document No. 81/55.
35. Mumtaz K, Hamid SS, Adil S et al (2005). Epidemiology and clinical pattern of hepatitis delta virus infection in Pakistan. J Gastroenterol Hepatol, 20 (10):1503-7.
36. Alavian SM, Alavian SH (2005). Hepatitis D Virus Infection; Iran, Middle East and Central Asia. Hepat Mon, 5 (4):137-43.
37. Bahcecioglu IH, Aygun C, Gozel N et al (2011). Prevalence of hepatitis delta virus (HDV) infection in chronic hepatitis B patients in eastern Turkey: still a serious problem to consider. J Viral Hepat, 18 (7):518-24.
38. Tahaei SM, Mohebbi SR, Azimzadeh P et al (2014). Prevalence of hepatitis D virus in hepatitis B virus infected patients referred to Taleghani hospital, Tehran, Iran. Gastroenterol Hepatol Bed Bench, 7 (3):144-50.
39. Ataei B, Yazdani MR, Kalantari H et al (2011). Hepatitis D virus infection in Isfahan, central Iran: Prevalence and risk factors among chronic HBV infection cases. Hepat Mon, 11 (4):269-72.
40. Hajiani E, Hashemi S, Jalali F (2009). Seroprevalence of delta hepatitis in patients with chronic hepatitis B and its clinical impact in Khuzestan province, southwest Iran. Hepat Mon, 9 (4):287-92.
41. Gu X, Li Q, Wang Y (2001). Clinical characteristics of the patients with hepatitis B combining hepatitis D infection. Zhonghua Gan Zang Bing Za Zhi, 9 (1):34-6.
42. Saracco G, Rosina F, Brunetto MR et al (1987). Rapidly progressive HBsAg-positive hepatitis in Italy. The role of hepatitis delta virus infection. J Hepatol, 5 (3):274-81.
43. Fattovich G, Boscaro S, Noventa F et al (1987). Influence of hepatitis delta virus infection on progression to cirrhosis in chronic hepatitis type B. J Infect Dis, 155 (5):931-5.
44. Colombo M, Cambieri R, Rumi MG, Ronchi G, Del Ninno E, De Franchis R (1983). Long-term delta superinfection in hepatitis B surface antigen carriers and its relationship to the course of chronic hepatitis. Gastroenterology, 85 (2):235-9.
45. Zachou K, Yurdaydin C, Drebber U et al (2010). Quantitative HBsAg and HDV-RNA levels in chronic delta hepatitis. Liver Int, 30 (3):430-7.
46. Fattovich G, Giustina G, Christensen E et al (2000). Influence of hepatitis delta virus infection on morbidity and mortality in compensated cirrhosis type B. The European Concerted Action on Viral Hepatitis (Eurohep). Gut, 46 (3):420-6.
47. Abbas Z, Jafri W, Raza S (2010). Hepatitis D: Scenario in the Asia-Pacific region. World J Gastroenterol, 16 (5):554-62.
48. Mumtaz K, Ahmed US, Memon S et al (2011). Virological and clinical characteristics of hepatitis delta virus in South Asia. Virol J, 8:312.
49. Khan AU, Waqar M, Akram M et al (2011). True prevalence of twin HDV-HBV infection in Pakistan: a molecular approach. Virol J, 8:420.
50. Kim HS, Kim SJ, Park HW et al (2011). Prevalence and clinical significance of hepatitis D virus co-infection in patients with chronic hepatitis B in Korea. J Med Virol, 83 (7):1172-7.
51. Ho E, Deltenre P, Nkuize M, Delwaide J, Colle I, Michielsen P (2013). Coinfection of hepatitis B and hepatitis delta virus in Belgium: a multicenter BASL study. Prospective epidemiology and comparison with HBV mono-infection. J Med Virol, 85 (9):1513-7.
52. Yurdaydin C, Idilman R, Bozkaya H, Bozdayi AM (2010). Natural history and treatment of chronic delta hepatitis. J Viral Hepat, 17 (11):749-56.
53. Xiridou M, Borkent-Raven B, Hulshof J, Wallinga J (2009). How hepatitis D virus can hinder the control of hepatitis B virus. PLoS One, 4(4):e5247.
54. Degertekin H, Yalcin K, Yakut M (2006). The prevalence of hepatitis delta virus infection in acute and chronic liver diseases in Turkey: an analysis of clinical studies. Turk J Gastroenterol, 17 (1):25-34.
55. Navascues CA, Rodriguez M, Sotorrio NG et al (1995). Epidemiology of hepatitis D virus infection: changes in the last 14 years. Am J Gastroenterol, 90 (11):1981-4.
56. Huo TI, Wu JC, Lin RY, Sheng WY, Chang FY, Lee SD (1997). Decreasing hepatitis D virus infection in Taiwan: an analysis of contributory factors. J Gastroenterol Hepatol, 12 (11):747-51.
57. Wedemeyer H, Heidrich B, Manns MP (2007). Hepatitis D virus infection--not a vanishing disease in Europe! Hepatology, 45 (5):1331-2.
58. Smith HM, Alexander GJ, Webb G et al (1992). Hepatitis B and delta virus infection among "at risk" populations in south east London. J Epidemiol Community Health, 46 (2):144-7.
59. Cross TJ, Rizzi P, Horner M et al (2008). The increasing prevalence of hepatitis delta virus (HDV) infection in South London. J Med Virol, 80 (2):277-82.
2. Liaw YF, Fabien Z (2015). Hepatitis B Virus in Human Diseases. Humana Press, New York.
3. Dandri M, Locarnini S (2012). New insight in the pathobiology of hepatitis B virus infection. Gut, 61 1:i6-17.
4. Hughes SA, Wedemeyer H, Harrison PM (2011). Hepatitis delta virus. Lancet, 378 (9785):73-85.
5. Rizzetto M (2015). Hepatitis D Virus: Introduction and Epidemiology. Cold Spring Harb Perspect Med, 5 (7):a021576.
6. Kao JH (2002). Hepatitis B viral genotypes: clinical relevance and molecular characteristics. J Gastroenterol Hepatol, 17 (6):643-50.
7. Poorolajal J, Majdzadeh R (2009). Prevalence of chronic hepatitis B infection in Iran: a review article. J Res Med Sci, 14 (4):249-58.
8. Lozano R, Naghavi M, Foreman K et al (2012). Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 380 (9859):2095-128.
9. Hadziyannis SJ, Papaioannou C, Alexopoulou A (1991). The role of the hepatitis delta virus in acute hepatitis and in chronic liver disease in Greece. Prog Clin Biol Res, 364:51-62.
10. Romeo R, Foglieni B, Casazza G et al (2014). High serum levels of HDV RNA are predictors of cirrhosis and liver cancer in patients with chronic hepatitis delta. PLoS One, 9 (3):e92062.
11. Abbas Z, Afzal R (2013). Life cycle and pathogenesis of hepatitis D virus: A review. World J Hepatol, 5 (12):666-75.
12. Pascarella S, Negro F (2011). Hepatitis D virus: an update. Liver Int, 31 (1):7-21.
13. Romeo R, Del Ninno E, Rumi M et al (2009). A 28-year study of the course of hepatitis Delta infection: a risk factor for cirrhosis and hepatocellular carcinoma. Gastroenterology, 136 (5):1629-38.
14. Alavian SM, Assari SH, Manzoori-Joybari H et al (2005). [Frequency and risk factors of hepatitis D virus in hepatitis B patients]. Govaresh, 10 (1):21-6.
15. Gholamreza R, Shahryar S, Abbasali K et al (2007). Seroprevalence of hepatitis B virus and its co-infection with hepatitis D virus and hepatitis C virus in Iranian adult population. Indian J Med Sci, 61 (5):263-8.
16. Rezvan H, Forouzandeh B, Taroyan S, Fadaiee S, Azordegan F (1990). A study on delta virus infection and its clinical impact in Iran. Infection, 18 (1):26-8.
17. Amini-Kafiabad S, Taghinia A, Khanbaba F, A. T (2004). [The prevalence of Delta agent super-infection and coinfection among HBsAg-positive patients referring to reference IBTO Lab]. Hakim Health Syst Res J, 9 (4):7-11.
18. Taghavi S-A, Sedighi S, Mehrabani D, Khademolhosseini F (2008). Hepatitis D in chronic active hepatitis B: prevalence, liver enzyme levels and histopathology-an epidemiological study in Shiraz, southern Iran, 2003-2004. Hepat Mon, 8 (4):248-51.
19. .Lefkowitch JH (2007). Liver biopsy assessment in chronic hepatitis. Arch Med Res, 38 (6):634-43.
20. Mohammad-Alizadeh AH, Ranjbar M, Tehrani AS et al (2010). Seroprevalence of hepatitis D virus and its risk factors in the west of Iran. J Microbiol Immunol Infect, 43 (6):519-23.
21. Al-Hilli HA, Al-Ugaidy YH (2002). Prevalence of hepatitis delta virus super infection in chronic HBV infection. IJGE, 1 (3):30-33.
22. Celen MK, Ayaz C, Hosoglu S, Geyik MF, Ulug M (2006). Anti-hepatitis delta virus seroprevalence and risk factors in patients with hepatitis B in Southeast Turkey. Saudi Med J, 27 (5):617-20.
23. Hussein NR, Rasheed ZA, Taha AA, Shaikhow SK (2015). The prevalence of hepatitis D Virus infection amongst patients with Chronic active hepatitis B Virus infection in Duhok Governorate. Int J Pure Appl Sci Technol, 28 (1):1-7.
24. Bakhshipour A, Mashhadi M, Mohammadi M, Nezam SK (2013). Seroprevalence and risk factors of hepatitis delta virus in chronic hepatitis B virus infection in Zahedan. Acta Med Iran, 51 (4):260-4.
25. Amini S, Mahmoodi MF, Andalibi S, Solati AA (1993). Seroepidemiology of hepatitis B, delta and human immunodeficiency virus infections in Hamadan province, Iran: a population based study. J Trop Med Hyg, 96 (5):277-87.
26. Ghamari S, Alavian SM, Rizzetto M et al (2013). Prevalence of hepatitis delta virus (HDV) infection in chronic hepatitis B patients with unusual clinical pictures. Hepat Mon, 13 (8):e6731.
27. Foupouapouognigni Y, Noah DN, Sartre MT, Njouom R (2011). High prevalence and predominance of hepatitis delta virus genotype 1 infection in Cameroon. J Clin Microbiol, 49 (3):1162-4.
28. Nwokediuko SC, Ijeoma U (2009). Seroprevalence of antibody to HDV in Nigerians with hepatitis B virus-related liver diseases. Niger J Clin Pract, 12 (4):439-42.
29. Acharya SK, Madan K, Dattagupta S, Panda SK (2006). Viral hepatitis in India. Natl Med J India, 19 (4):203-17.
30. Louisirirotchanakul S, Myint KS, Srimee B et al (2002). The prevalence of viral hepatitis among the Hmong people of northern Thailand. Southeast Asian J Trop Med Public Health, 33 (4):837-44.
31. Zaki H, Darmstadt GL, Baten A, Ahsan CR, Saha SK (2003). Seroepidemiology of hepatitis B and delta virus infections in Bangladesh. J Trop Pediatr, 49 (6):371-4.
32. Ghadir MR, Belbasi M, Heidari A et al (2012). Prevalence of hepatitis d virus infection among hepatitis B virus infected patients in qom province, center of iran. Hepat Mon, 12 (3):205-8.
33. Hassanjani Roshan M, Baiki A, Soleimani M (2002). [Prevalence of anti-HDV in chronic carrier of HBV in Babol]. J Babol Univ Med Sci, 6:50-54.
34. Zahedi M (2003). [Serologic Prevalence of Hepatitis D in HBsAg Positive Patients in Kerman, South of Iran, 2002-2003]. Kerman Univ Med Sci Health Serv, Document No. 81/55.
35. Mumtaz K, Hamid SS, Adil S et al (2005). Epidemiology and clinical pattern of hepatitis delta virus infection in Pakistan. J Gastroenterol Hepatol, 20 (10):1503-7.
36. Alavian SM, Alavian SH (2005). Hepatitis D Virus Infection; Iran, Middle East and Central Asia. Hepat Mon, 5 (4):137-43.
37. Bahcecioglu IH, Aygun C, Gozel N et al (2011). Prevalence of hepatitis delta virus (HDV) infection in chronic hepatitis B patients in eastern Turkey: still a serious problem to consider. J Viral Hepat, 18 (7):518-24.
38. Tahaei SM, Mohebbi SR, Azimzadeh P et al (2014). Prevalence of hepatitis D virus in hepatitis B virus infected patients referred to Taleghani hospital, Tehran, Iran. Gastroenterol Hepatol Bed Bench, 7 (3):144-50.
39. Ataei B, Yazdani MR, Kalantari H et al (2011). Hepatitis D virus infection in Isfahan, central Iran: Prevalence and risk factors among chronic HBV infection cases. Hepat Mon, 11 (4):269-72.
40. Hajiani E, Hashemi S, Jalali F (2009). Seroprevalence of delta hepatitis in patients with chronic hepatitis B and its clinical impact in Khuzestan province, southwest Iran. Hepat Mon, 9 (4):287-92.
41. Gu X, Li Q, Wang Y (2001). Clinical characteristics of the patients with hepatitis B combining hepatitis D infection. Zhonghua Gan Zang Bing Za Zhi, 9 (1):34-6.
42. Saracco G, Rosina F, Brunetto MR et al (1987). Rapidly progressive HBsAg-positive hepatitis in Italy. The role of hepatitis delta virus infection. J Hepatol, 5 (3):274-81.
43. Fattovich G, Boscaro S, Noventa F et al (1987). Influence of hepatitis delta virus infection on progression to cirrhosis in chronic hepatitis type B. J Infect Dis, 155 (5):931-5.
44. Colombo M, Cambieri R, Rumi MG, Ronchi G, Del Ninno E, De Franchis R (1983). Long-term delta superinfection in hepatitis B surface antigen carriers and its relationship to the course of chronic hepatitis. Gastroenterology, 85 (2):235-9.
45. Zachou K, Yurdaydin C, Drebber U et al (2010). Quantitative HBsAg and HDV-RNA levels in chronic delta hepatitis. Liver Int, 30 (3):430-7.
46. Fattovich G, Giustina G, Christensen E et al (2000). Influence of hepatitis delta virus infection on morbidity and mortality in compensated cirrhosis type B. The European Concerted Action on Viral Hepatitis (Eurohep). Gut, 46 (3):420-6.
47. Abbas Z, Jafri W, Raza S (2010). Hepatitis D: Scenario in the Asia-Pacific region. World J Gastroenterol, 16 (5):554-62.
48. Mumtaz K, Ahmed US, Memon S et al (2011). Virological and clinical characteristics of hepatitis delta virus in South Asia. Virol J, 8:312.
49. Khan AU, Waqar M, Akram M et al (2011). True prevalence of twin HDV-HBV infection in Pakistan: a molecular approach. Virol J, 8:420.
50. Kim HS, Kim SJ, Park HW et al (2011). Prevalence and clinical significance of hepatitis D virus co-infection in patients with chronic hepatitis B in Korea. J Med Virol, 83 (7):1172-7.
51. Ho E, Deltenre P, Nkuize M, Delwaide J, Colle I, Michielsen P (2013). Coinfection of hepatitis B and hepatitis delta virus in Belgium: a multicenter BASL study. Prospective epidemiology and comparison with HBV mono-infection. J Med Virol, 85 (9):1513-7.
52. Yurdaydin C, Idilman R, Bozkaya H, Bozdayi AM (2010). Natural history and treatment of chronic delta hepatitis. J Viral Hepat, 17 (11):749-56.
53. Xiridou M, Borkent-Raven B, Hulshof J, Wallinga J (2009). How hepatitis D virus can hinder the control of hepatitis B virus. PLoS One, 4(4):e5247.
54. Degertekin H, Yalcin K, Yakut M (2006). The prevalence of hepatitis delta virus infection in acute and chronic liver diseases in Turkey: an analysis of clinical studies. Turk J Gastroenterol, 17 (1):25-34.
55. Navascues CA, Rodriguez M, Sotorrio NG et al (1995). Epidemiology of hepatitis D virus infection: changes in the last 14 years. Am J Gastroenterol, 90 (11):1981-4.
56. Huo TI, Wu JC, Lin RY, Sheng WY, Chang FY, Lee SD (1997). Decreasing hepatitis D virus infection in Taiwan: an analysis of contributory factors. J Gastroenterol Hepatol, 12 (11):747-51.
57. Wedemeyer H, Heidrich B, Manns MP (2007). Hepatitis D virus infection--not a vanishing disease in Europe! Hepatology, 45 (5):1331-2.
58. Smith HM, Alexander GJ, Webb G et al (1992). Hepatitis B and delta virus infection among "at risk" populations in south east London. J Epidemiol Community Health, 46 (2):144-7.
59. Cross TJ, Rizzi P, Horner M et al (2008). The increasing prevalence of hepatitis delta virus (HDV) infection in South London. J Med Virol, 80 (2):277-82.
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| Issue | Vol 47 No 12 (2018) | |
| Section | Original Article(s) | |
| Keywords | ||
| Hepatitis delta virus Chronic active hepatitis B virus Coinfection Seroprevalence Iran | ||
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How to Cite
1.
SHARIFAN P, AMOUEIAN S. Histological and Serological Epidemiology of Hepatitis Delta Virus Coinfection among Patients with Chronic Active Hepatitis B Virus in Razavi Khorasan Province, Northeastern Iran. Iran J Public Health. 2018;47(12):1906-1912.
