HDV infection in Isfahan Table 3. Odds ratios of risk factors of hepatitis D virus infection Variable Age Sex a Marital status b Duration of HBV infection History of surgery c History of blood transfusion c History of hepatitis in the family c History of dental manipulation c History of Phlebotomy HBe antigen d HBe antibody d OR (95% CI) 0.97 (0.92-1.01) 0.6 (0.16-2.19) 31.11 (1.79-537.93) e 1.02 (0.84-1.24) 0.94 (0.26-3.41) 0.89 (0.11-7.24) 1.31 (0.36-4.74) 073 (0.15-3.57) 1.19 (0.24-5.74) 0.72 (0.15-3.46) 2.04 (0.42-9.79) Ataei B et al. 271 adjusted OR (95% CI) 0.96 (0.91-1.02) 1.97 (0.42-9.23) 1.12 (0.11-11) 1.03 (0.8-1.32) 1.54 (0.36-6.6) 1.09 (0.12-10) 0.82 (0.21-3.14) 1.47 (0.29-7.5) 0.86 (0.15-4.75) 0.44 (0.02-8.04) 0.32 (0.02-5. 85) a female = 0 male = 1 (Reference category) b single and widowed = 0, married = 1 (Reference category) c has not had = 0, has had = 1 (Reference category) d negative = 0, positive = 1 (Reference category) e statistically significant Results Overall, 346 cases, comprising 245 men (70.8%) and 101 women (29.2%) with a mean age of 39 ± 12.4 years (40.4 ± 11.8 and 35.8 ± 13.2 years, respectively, p-value = 0.003), were studied. The median time from diagnosis of infec- tion with hepatitis B virus was 3 years (range, 1 month to 31 years). With regard to marital status, 54 cases (15.6%) were single, 290 cases (83.8%) were married, and 2 pa- tients (0.6%) were widowed. With regard to mode of diagnosis, the HBV was detect- ed by disease-related follow up in 130 cases (37.6%), famil- ial check-up in 105 cases (30.3%), by individual testing in 30 cases (8.7%), after blood donation in 69 cases (19.9 %), during pregnancy in 10 patients (2.9%), and by congenital assay in 2 cases (0.6%). The distribution of frequencies of risk factors for hepa- titis B is shown in Table 1. Ten cases (2.9%) had antibodies against hepatitis D virus (6 males = 2.4% and 4 females = 4%, p-value = 0.44). The status of HDV infection relative to hepatitis B is shown in Table 2. We observed that 3.5% of HBeAb-positive patients and 2.3% of HBeAg-positive patients had HDV antibody; ie, the prevalence of HDV Ab was higher in HBeAb-positive patients compared with HBeAg-positive patients. On analysis of demographic and risk factors by logistic regression, no statistically significant relationship was noted between hepatitis D and probable risk factors. We calculated odds ratios (ORs) with 95% confidence inter- vals (CI) of various factors, presented in Table 3. Multivari- ate logistic regression analysis was used to control for the confounding effects of other variables and estimate the adjusted odds ratios, shown in Table 3. Discussion The prevalence of serum HDV antibody in our study group was 2.9%. In this study, a family history of hepati- tis, phlebotomy, surgery, blood transfusions, and dental manipulations were the most frequent risk factors in pa- tients with HDV antibody. Based on studies in Mediterranean countries, including the Middle East, HDV infection is transmitted primarily through noncutaneous routes, especially close personal contact, such as that between family members (3). Based on the results of this study and other reports, HDV trans- mission and spread can be prevented by avoidance of an infected person in close family relationships, and the disease can be diagnosed earlier by screening high-risk individuals and their families. In 1990, Rezvan et al. detected HDV antibodies in 2.5% of asymptomatic HsAg carriers in Tehran, the capital of Iran (12). Karimi et al. in 2000 reported a 1.3% prevalence of HDV in chronic carriers of hepatitis B in Tehran (13). Amini et al. reported prevalence (2.4%) of HDV infection in similar research population in 1993 in Hamadan, western Iran (14). In 2000 in Babol, northern Iran, Hassanjani-Roshan and Taheri observed HDV positivity in 2% of HBV carriers (3). Roshandel and colleagues reported a 5.8% prevalence of HDV in Golestan, northern Iran, in 2008 (15). In Tabriz, northwestern Iran, in 2002,,Torabi and colleagues noted a prevalence of HDV antibody of 0.6% in HBsAg-positive individuals (16). Alavian et al. reported 5.7% HDV sero- positivity among HBV-infected subjects in Iran (17). These studies demonstrate that the prevalence of HBV/HDV coinfection and superinfection has increased in the past decade in Iran, during which the prevalence of acute and chronic hepatitis D has decreased worldwide (18). The prevalence of HDV among HBsAg-positive individu- als has been reported to be 1.5% in Yugoslavia (19), 1.6% in Spain (10), 2.2% in Taiwan (20), 4% in Mexico (21), 16.6% in Pakistan (22), 24.4% in Bangladesh (1), 12.5% in Russia (7), 83.3% in Romania (5), 23.6% in Japan (23), and 8.3% in Italy (6). These studies suggest that the prevalence of HDV dif- fers in various parts of the world and is higher in east- Hepat Mon. 2011;11(4):269-272