Characterization of hepatitis B and delta coinfection in Israel

Rachel Shirazi, Daniela Ram, Aviya Rakovsky, Efrat Bucris, Yael Gozlan, Yaniv Lustig, Pninit Shaked-Mishan, Orit Picard, Yonat Shemer-Avni, Haim Ben-Zvi, Ora Halutz, Yoav Lurie, Ella Veizman, Matthias Carlebach, Marius Braun, Michal Cohen Naftaly, Amir Shlomai, Rifaat Safadi, Ella Mendelson, Ella H. SklanZiv Ben-Ari, Orna Mor*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Characteristics of hepatitis B (HBV) and delta (HDV) coinfection in various geographical regions, including Israel, remain unclear. Here we studied HDV seroprevalence in Israel, assessed HDV/HBV viral loads, circulating genotypes and hepatitis delta antigen (HDAg) conservation. Methods: Serological anti HDV IgG results from 8969 HBsAg positive individuals tested in 2010-2015 were retrospectively analyzed to determine HDV seroprevalence. In a cohort of HBV/HDV coinfected (n=58) and HBV monoinfected (n=27) patients, quantitative real-time PCR (qRT-PCR) and sequencing were performed to determine viral loads, genotypes and hepatitis delta antigen (HDAg) protein sequence. Results: 6.5% (587/8969) of the HBsAg positive patients were positive for anti HDV antibodies. HDV viral load was >2 log copies/ml higher than HBV viral load in most of the coinfected patients with detectable HDV RNA (86%, 50/58). HDV genotype 1 was identified in all patients, most of whom did not express HBV. While 66.6% (4/6) of the HBV/HDV co-expressing patients carried HBV-D2 only 18.5% (5/27) of the HBV monoinfections had HBV-D2 (p=0.03). Higher genetic variability in the HDAg protein sequence was associated with higher HDV viral load. Conclusions: The overall significant prevalence of HDV (6.5%) mandates HDV RNA testing for all coinfected patients. Patients positive for HDV RNA (characterized by low HBV DNA blood levels) carried HDV genotype 1. Taken together, the significant HDV seroprevalence and the lack of effective anti-HDV therapy, necessitates strict clinical surveillance especially in patients with higher HDV viral loads and increased viral evolution.

Original languageEnglish
Article number97
JournalBMC Infectious Diseases
Issue number1
StatePublished - 27 Feb 2018


  • HBV genotype
  • HBV/HDV viral load
  • HDV genotype
  • Hepatitis B (HBV)
  • Hepatitis delta (HDV)
  • Seroprevalence


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