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People coinfected with HBV<\/jats:styled-content> and hepatitis D virus (HDV<\/jats:styled-content>) have an even greater risk of HCC<\/jats:styled-content> and cirrhosis. Using a new HDV<\/jats:styled-content> quantitative microarray antibody capture (Q\u2010MAC<\/jats:styled-content>) assay, we evaluated the association between HDV<\/jats:styled-content> infection and HCC<\/jats:styled-content> or cirrhosis among participants in The Gambia Liver Cancer Study. In this case\u2010control study, cases had HCC<\/jats:styled-content> (n\u00a0=\u00a0312) or cirrhosis (n\u00a0=\u00a0119). Controls (n\u00a0=\u00a0470) had no clinical evidence of liver disease and normal serum alpha\u2010foetoprotein. Participants were previously tested for hepatitis B surface antigen (HB<\/jats:styled-content>sAg); we tested HB<\/jats:styled-content>sAg+ specimens by HDV<\/jats:styled-content> Q\u2010MAC<\/jats:styled-content>, western blot and RNA<\/jats:styled-content> assays. We evaluated separate cut\u2010offs of the Q\u2010MAC<\/jats:styled-content> assay for predicting anti\u2010HDV<\/jats:styled-content> and RNA<\/jats:styled-content> positivity. Q\u2010MAC<\/jats:styled-content> correctly identified 29\/29 subjects who were western blot\u2010positive (sensitivity\u00a0=\u00a0100%, specificity\u00a0=\u00a099.4%) and 16\/17 who were RNA<\/jats:styled-content>\u2010positive (sensitivity\u00a0=\u00a094.1%, specificity\u00a0=\u00a0100%). Compared to controls, cases more often had HBV<\/jats:styled-content> monoinfection (HB<\/jats:styled-content>sAg+\/HDV RNA<\/jats:styled-content>\u2212; 54.1% vs 17.0%; odds ratio [OR<\/jats:styled-content>]\u00a0=\u00a06.28; P<\/jats:italic>\u00a0<\u00a00.001) or HBV<\/jats:styled-content>\u2010HDV<\/jats:styled-content> coinfection (HB<\/jats:styled-content>sAg+\/HDV RNA<\/jats:styled-content>+; 3.9% vs 0%; P<\/jats:italic>\u00a0<\u00a00.001). Risk estimates (for HCC<\/jats:styled-content> or cirrhosis) based on HDV<\/jats:styled-content> antibody status and adjusted for covariates (demographics, alcohol, smoking, body mass index, anti\u2010HCV<\/jats:styled-content> and aflatoxin B1 exposure) yielded consistent results for both HBV<\/jats:styled-content> monoinfection (adjusted OR<\/jats:styled-content>\u00a0=\u00a08.29; 95% confidence interval\u00a0=\u00a05.74\u201011.98) and HBV<\/jats:styled-content>\u2010HDV<\/jats:styled-content> coinfection (adjusted OR<\/jats:styled-content>\u00a0=\u00a030.66; 95% confidence interval\u00a0=\u00a06.97\u2010134.95). In this Gambian population, HDV<\/jats:styled-content> Q\u2010MAC<\/jats:styled-content> had high sensitivity and specificity for both anti\u2010HDV<\/jats:styled-content> and HDV RNA<\/jats:styled-content>. HDV<\/jats:styled-content> infection contributed to the high risk of HCC<\/jats:styled-content> in The Gambia.<\/jats:p>","DOI":"10.1111\/jvh.13065","type":"journal-article","created":{"date-parts":[[2019,1,20]],"date-time":"2019-01-20T10:54:22Z","timestamp":1547981662000},"page":"738-749","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Hepatitis D virus infection, cirrhosis and hepatocellular carcinoma in The Gambia"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1285-3310","authenticated-orcid":false,"given":"Parag","family":"Mahale","sequence":"first","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics National Cancer Institute Rockville Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Aka","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics National Cancer Institute Rockville Maryland"},{"name":"International Health Division Demographic and Health Surveys ICF International Rockville Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohua","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Department of Medicine Stanford University School of Medicine Palo Alto California"},{"name":"Department of Infectious Disease Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth M.","family":"Pfeiffer","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics National Cancer Institute Rockville Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Department of Medicine Stanford University School of Medicine Palo Alto California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Groover","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics National Cancer Institute Rockville Maryland"},{"name":"Department of Biochemistry and Microbiology Oklahoma State University Center for Health Sciences Tulsa Oklahoma"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maimuna","family":"Mendy","sequence":"additional","affiliation":[{"name":"International Agency for Research on Cancer Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramou","family":"Njie","sequence":"additional","affiliation":[{"name":"International Agency for Research on Cancer Lyon France"},{"name":"Hepatitis Unit Disease Control & Elimination Medical Research Council Unit The Gambia Fajara The Gambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James J.","family":"Goedert","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics National Cancer Institute Rockville Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory D.","family":"Kirk","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey S.","family":"Glenn","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Department of Medicine Stanford University School of Medicine Palo Alto California"},{"name":"Department of Microbiology and Immunology Stanford University School of Medicine Palo Alto California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas R.","family":"O'Brien","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics National Cancer Institute 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