@article{8736016,
  abstract     = {{Hepatitis D virus (HDV) infection causes a severe chronic viral hepatitis with accelerated development of liver cirrhosis and decompensation, but whether it further increases the risk of hepatocellular carcinoma (HCC) is unclear. We performed a comprehensive systematic review of the published literature and meta-analysis to assess the risk of HCC in HDV and hepatitis B virus (HBV) co-infected, compared to HBV mono-infected patients. The study was conducted per a priori defined protocol, including only longitudinal studies, thus excluding cross-sectional studies. Random-effects models were used to determine aggregate effect sizes (ES) with 95% confidence intervals (CI). Meta-regression was used to examine the associations among study level characteristics. Twelve cohort studies comprising a total of 6099 HBV/HDV co-infected and 57,620 chronic HBV mono-infected patients were analysed. The overall pooled ES showed that HBV/HDV co-infected patients were at 2-fold increased risk of HCC compared to HBV mono-infected patients (ES = 2.12, 95% CI 1.14-3.95, I-2 = 72%, N = 12). A six-fold significant increased risk of HCC was noted among HIV/HBV/HDV triple-infected, compared to HIV/HBV co-infected patients. The magnitude of ES did not differ significantly after adjustment for study design and quality, publication year and follow-up duration in univariable meta-regression analysis. This systematic review and meta-analysis shows that infection with HDV is associated with a 2-fold higher risk of HCC development compared to HBV mono-infection. HCC surveillance strategies taking this increased risk into account, and new treatment options against HDV, are warranted.}},
  author       = {{Kamal, Habiba and Fornes, Romina and Simin, Johanna and Stal, Per and Duberg, Ann-Sofi and Brusselaers, Nele and Aleman, Soo}},
  issn         = {{1352-0504}},
  journal      = {{JOURNAL OF VIRAL HEPATITIS}},
  keywords     = {{cirrhosis,HCC,HDV,hepatitis B,hepatitis delta,hepatocellular carcinoma,meta-analysis,systematic review,DELTA-HEPATITIS,SURFACE-ANTIGEN,PREVALENCE,CIRRHOSIS,SUPERINFECTION,EPIDEMIOLOGY,PROGRESSION,THERAPY,IMPACT}},
  language     = {{eng}},
  number       = {{10}},
  pages        = {{1431--1442}},
  title        = {{Risk of hepatocellular carcinoma in hepatitis B and D virus co-infected patients : a systematic review and meta-analysis of longitudinal studies}},
  url          = {{http://doi.org/10.1111/jvh.13577}},
  volume       = {{28}},
  year         = {{2021}},
}

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