Hepatitis D and hepatocellular carcinoma

Table 1 The epidemiological studies on the role of hepatitis D virus infection in increasing the risk of hepatocellular carcinoma

1Romeo et al[27]	193 patients with HDV co-infection were investigated for a median of 9.5 yr. HDV RNA levels appeared significantly associated with HCC
1Romeo et al[25]	299 HDV infected patients invstigated over 28 yr. Persistent HDV leads to cirrhosis and HCC at annual rates of 4% and 2.8%
1Oyunsuren et al[28]	292 chronic hepatitis patients were investigated retrospectively. HDV co-infection has a stronger association with HCC development at a younger age than HCV mono-infection
1Fattovich et al[14] (EUROHEP study group)	A retrospective cohort study of 200 Western European patients was carried out with a follow-up median period of 6.6 yr. HDV infection increases the risk of HCC three-fold
1Cenac et al[29]	89 Sahelian African patients were tested alongside 47 controls. 55% of HDV patients had HCC compared to the 17% who had HBV mono-infection with HCC
1Oliveri et al[30]	Patients with HDV co-infection developed HCC at a significantly younger age than those affected by HBV alone, by about 10 yr
1Tamura et al[22]	1127 patients were followed for atleast 3 yr. The prevalence was 4.05 per thousand person years in HDV co-infection patients compared to 2.73 in patients with HBV alone
1Verme et al[31]	62 patients were investigated. The findings suggest that HDV co-infection causes HCC at an earlier age
1Smedile et al[32]	85 patients were investigated. The outcome in patients with HDV co-infection was significantly worse than others
1Trichopoulos et al[19]	116 patients were investigated. There is a higher prevalence of HCC amongst HDV co-infected patients
1Toukan et al[18]	The highest prevalence of HCC was found in those patients co-infected with HDV
1Ji et al[26]	650 out of 9160 HBV patients had HDV. The median follow up was 11 yr. The risk of HCC was increased. HDV was a strong risk factor
2Huang et al[33]	114 HCC patients were investigated prior to surgery. A higher prevalence of hepatic inflammation was observed in HCV patients and also, possibly, in HDV patients
2Abbas et al[11]	92 HDV positive and 92 negative patients with HCC were compared. HDV causes HCC in a different manner to HBV
3Heidrich et al[6]	71 out of 534 patients had HBV and HDV co-infection. The median follow-up period was 4.25 yr. The long-term outcome for HBeAg positive and negative was the same
3Huo et al[23]	42 HDV co-infected patients were compared to 255 HBV patients, all with HCC, over a period of 8 yr. HDV co-infection does not accelerate HCC development, and the outcomes are the same as HBV mono-infection
3Fattovich et al[13] (EUROHEP study group)	349 Western European patients were investigated for 5 yr. HDV co-infection had no prognostic value for the development of HCC
3Realdi et al[34] (EUROHEP)	366 caucasian patients were investigated for 6 yr. HDV infection did not influence the prognosis
3Kage et al[35]	58 patients were investigated. HDV is unlikely to have a role in the development of HCC
3Tzonou et al[36]	185 cases with HCC and 432 hospital controls were investigated. HDV was not a significant cause of HCC
3Tassopoulos et al[37]	47 patients with HCC were investigated. None of the 47 had any evidence of HDV infection
3Chen et al[38]	60 patients were investigated. However, the study indicated that HDV co-infection does not lead to a rise in HCC development amongst Chinese living in Taiwan
3Govindarajan et al[39]	Sera from 39 patients with HBV associated with HCC were studied for the presence of HDV. Only one patient tested positive
3Negro et al[40]	Liver tissues of 19 patients with chronic HDV were investigated and compared to tissues from 16 patients with chronic HBV, and 3 normal patients. Hepatocyte proliferation in HDV was similar to HBV, but higher than normal

¹Studies favoring role of HDV in HCC;

²Inconclusive;

³Studies against role of HDV in HCC. HDV: Hepatitis D virus; HCC: Hepatocellular carcinoma; HBV: Hepatitis B virus; HBeAg: Hepatitis B e antigen; HCV: Hepatitis C virus.