Hepatitis D virus infection, cirrhosis and hepatocellular carcinoma in The Gambia

Parag Mahale, Peter Aka, Xiaohua Chen, Ruth M. Pfeiffer, Ping Liu, Sarah Groover, Maimuna Mendy, Ramou Njie, James J. Goedert, Gregory D Kirk, Jeffrey S. Glenn, Thomas R. O'Brien

Research output: Contribution to journalArticle


Hepatocellular carcinoma (HCC) incidence is high in The Gambia, and hepatitis B virus (HBV) infection is the main cause. People coinfected with HBV and hepatitis D virus (HDV) have an even greater risk of HCC and cirrhosis. Using a new HDV quantitative microarray antibody capture (Q-MAC) assay, we evaluated the association between HDV infection and HCC or cirrhosis among participants in The Gambia Liver Cancer Study. In this case-control study, cases had HCC (n = 312) or cirrhosis (n = 119). Controls (n = 470) had no clinical evidence of liver disease and normal serum alpha-foetoprotein. Participants were previously tested for hepatitis B surface antigen (HBsAg); we tested HBsAg+ specimens by HDV Q-MAC, western blot and RNA assays. We evaluated separate cut-offs of the Q-MAC assay for predicting anti-HDV and RNA positivity. Q-MAC correctly identified 29/29 subjects who were western blot-positive (sensitivity = 100%, specificity = 99.4%) and 16/17 who were RNA-positive (sensitivity = 94.1%, specificity = 100%). Compared to controls, cases more often had HBV monoinfection (HBsAg+/HDV RNA−; 54.1% vs 17.0%; odds ratio [OR] = 6.28; P < 0.001) or HBV-HDV coinfection (HBsAg+/HDV RNA+; 3.9% vs 0%; P < 0.001). Risk estimates (for HCC or cirrhosis) based on HDV antibody status and adjusted for covariates (demographics, alcohol, smoking, body mass index, anti-HCV and aflatoxin B1 exposure) yielded consistent results for both HBV monoinfection (adjusted OR = 8.29; 95% confidence interval = 5.74-11.98) and HBV-HDV coinfection (adjusted OR = 30.66; 95% confidence interval = 6.97-134.95). In this Gambian population, HDV Q-MAC had high sensitivity and specificity for both anti-HDV and HDV RNA. HDV infection contributed to the high risk of HCC in The Gambia.

Original languageEnglish (US)
JournalJournal of viral hepatitis
Publication statusPublished - Jan 1 2019



  • epidemiology
  • hepatitis B virus
  • hepatitis D virus
  • hepatocellular carcinoma

ASJC Scopus subject areas

  • Hepatology
  • Infectious Diseases
  • Virology

Cite this

Mahale, P., Aka, P., Chen, X., Pfeiffer, R. M., Liu, P., Groover, S., ... O'Brien, T. R. (2019). Hepatitis D virus infection, cirrhosis and hepatocellular carcinoma in The Gambia. Journal of viral hepatitis. https://doi.org/10.1111/jvh.13065