Hepatitis delta virus co-infection in patients with hepatocellular carcinoma and people living with HIV in Nigeria

INTRODUCTION: Despite Nigeria’s high burden of hepatitis B virus (HBV), the epidemiological landscape of hepatitis D virus (HDV) remains largely unexplored. Consequently, HDV remains under-recognized as a public health concern, slowing down efforts to improve surveillance and clinical care. We investigated HDV infection among distinct HBV-positive populations in Nigeria, including individuals with chronic HBV infection living with or without HIV and those with hepatocellular carcinoma (HCC) and/or cirrhosis. METHOD: A cross-sectional study that involved 390 HBV-infected adults recruited from five tertiary-level hospitals in Nigeria. HDV total antibodies (anti-HDV) were determined in 379 samples using an automated chemiluminescent immunoassay. HDV-RNA quantification was performed in all 379 patients. Samples with detectable HDV-RNA were subjected to Sanger sequencing, and results analyzed using bioinformatics tools. RESULTS: The overall anti-HDV antibody (HDV-Ab) seroprevalence was 8.1% with a significant difference observed across individual clinical groups: 4.1%, 11.0%, and 15.2% in asymptomatic HBV carriers, HCC/cirrhosis, HIV/HBV co-infection, respectively. Compared with asymptomatic HBV participants, HCC/cirrhosis (adjusted OR 2.71, 95% CI 1.04–7.48) and HIV/HBV (adjusted OR 3.28, 95% CI 1.20–9.25) groups had higher odds of anti-HDV positivity. HDV-RNA was detectable in 22.6% of all anti-HDV positive samples, with viral load ranging from 26.9 IU/mL to 234,000 IU/mL. HDV genotypes 1 and 5 were identified in HDV-RNA detectable samples. CONCLUSION: This study reveals higher anti-HDV rates in HIV/HBV coinfected individuals and suggests HDV as a significant contributor to liver cancer burden in Nigeria. These findings underscore the need for routine HDV screening among high-risk HBV-infected populations to enhance early detection and guide clinical management.