Dear Editor,
I read with interest the recently published article by Shadmand et al. (1) in your Journal. The authors presented the epidemiology of hepatitis E and D infections among human immune deficiency virus (HIV)-infected and HIV/hepatitis C virus (HCV)-co-infected patients. They concluded that two (2.7%) cases were positive for anti-hepatitis D virus (HDV) total antibody and one (1.4%) case was positive for anti-HDV IgM antibody. I would like to highlight some points about the prevalence of HDV infection in this study population.
Hepatitis delta infection is caused by co-infection of hepatitis B virus (HBV) and HDV or super-infection of HDV in patients with HBV infection. In other words, HDV cannot replicate and infect the hepatocytes in the absence of HBV (2). The authors did not present any data about HBV infection in this high-risk group in their study and they merely calculated the prevalence of HDV infection in the whole study population. Patients with HIV infection are at high risk of HBV and HDV infection acquisition and coinfection with HIV/HBV/HDV increases the risk of liver-related and other complications (3).
