The role of hepatitis D virus in liver disease in the Middle East.

Hepatitis D virus appears to be endemic in the Middle East, but its distribution bears little relationship to that of HBV. Only in Jordan was an association between HDV-positive status and HBsAg-positive primary hepatocellular carcinoma found. Fulminant hepatitis and chronic sequelae were unusual in HDV-coinfection, while early mortality and a chronic outcome were commoner in HDV-superinfection. In established HBsAg-positive cirrhosis survival was not significantly different in the HDV-positive vs. the HDV-negative patients. In patients whose biopsies showed cirrhosis, severe necroinflammatory features were seen more often in the HDV-positive than in HDV-negative patients.