Anwar Hussain Abbasi, Amna Riaz, Hina Analeeb, Muhammad Omar Qureshi, Nadeem Yousuf, Khawaja Ashfaque Ahmed


AIM: The aim of this study was to investigate the virological and biochemical characteristics of patients infected with HBV mono-infection and HDV/HBV co-infection; and to determine risk factors associated with development of liver cirrhosis.

METHODS: Cross-sectional study in which 586 HBV patients were identified based on testing on ELISA. Important characteristics were extracted. Patients with anti-HDV positive status were also identified. Liver cirrhosis was based on APRI (>1.5) or/and FIB4 (>1.45); or/and Fibroscan (F4). HBV-DNA level ˂2,000 IU and ˃20,000 IU were categorized to label patients with low and high viral load, respectively. HB surface Ag (HBsAg) was categorized as low when titer was ˂10 IU/ml.

RESULTS: Among all, mono-infected HBsAg patients was higher (52.04%) as compared to patients co-infected with HDV (11.77%). Patients with HDV coinfection had higher risk of having liver cirrhosis as compared to patients with HBV mono-infection, 33 (23.74%) vs. 39 (28.05%), respectively. Most of the risk predictors such as increasing age, raised AST, APRI, and FIB4 scores, and low platelet counts were similar in both groups but surprisingly liver cirrhosis may occur irrespective of raised bilirubin, AST, and HBV DNA levels in coinfected HBV/HDV patients, p <0.05.

CONCLUSION: Liver cirrhosis and hepatocellular carcinoma in patients with HBV/HDV co-infection appears to be more prevalent compared to HBV mono-infection. Liver cirrhosis occurs at younger age in patients with HBV/HDV co-infection as compared to HBV mono-infection. Among HBV/HDV co-infected patients cirrhosis status was independent of HBV viral load.


Liver cirrhosis, predictive factors, viral hepatitis, hepatitis B virus, Hepatitis Delta co-infection, Pakistan



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