{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T10:54:44Z","timestamp":1794048884943,"version":"4.8.0"},"reference-count":49,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2021,7,28]],"date-time":"2021-07-28T00:00:00Z","timestamp":1627430400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100018713","name":"Center for Innovative Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100018713","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Viral Hepatitis"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    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\u2010analysis to assess the risk of HCC in HDV and hepatitis B virus (HBV) co\u2010infected, compared to HBV mono\u2010infected patients. The study was conducted per\n                    <jats:italic>a priori<\/jats:italic>\n                    defined protocol, including only longitudinal studies, thus excluding cross\u2010sectional studies. Random\u2010effects models were used to determine aggregate effect sizes (ES) with 95% confidence intervals (CI). Meta\u2010regression was used to examine the associations among study level characteristics. Twelve cohort studies comprising a total of 6099 HBV\/HDV co\u2010infected and 57,620 chronic HBV mono\u2010infected patients were analysed. The overall pooled ES showed that HBV\/HDV co\u2010infected patients were at 2\u2010fold increased risk of HCC compared to HBV mono\u2010infected patients (ES\u00a0=\u00a02.12, 95% CI 1.14\u20133.95,\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u00a0=\u00a072%, N\u00a0=\u00a012). A six\u2010fold significant increased risk of HCC was noted among HIV\/HBV\/HDV triple\u2010infected, compared to HIV\/HBV co\u2010infected patients. The magnitude of ES did not differ significantly after adjustment for study design and quality, publication year and follow\u2010up duration in univariable meta\u2010regression analysis. This systematic review and meta\u2010analysis shows that infection with HDV is associated with a 2\u2010fold higher risk of HCC development compared to HBV mono\u2010infection. HCC surveillance strategies taking this increased risk into account, and new treatment options against HDV, are warranted.\n                  <\/jats:p>","DOI":"10.1111\/jvh.13577","type":"journal-article","created":{"date-parts":[[2021,7,22]],"date-time":"2021-07-22T04:45:22Z","timestamp":1626929122000},"page":"1431-1442","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":71,"title":["Risk of hepatocellular carcinoma in hepatitis B and D virus co\u2010infected patients: A systematic review and meta\u2010analysis of longitudinal studies"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6662-7813","authenticated-orcid":false,"given":"Habiba","family":"Kamal","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases Karolinska University Hospital Stockholm Sweden"},{"name":"Department of Medicine Huddinge Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4862-3819","authenticated-orcid":false,"given":"Romina","family":"Fornes","sequence":"additional","affiliation":[{"name":"Centre for Translational Microbiome Research (CTMR) Department of Microbiology Tumor and Cell biology (MTC) Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Simin","sequence":"additional","affiliation":[{"name":"Centre for Translational Microbiome Research (CTMR) Department of Microbiology Tumor and Cell biology (MTC) Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"St\u00e5l","sequence":"additional","affiliation":[{"name":"Department of Medicine Huddinge Karolinska Institutet Stockholm Sweden"},{"name":"Department of Upper GI Karolinska University Hospital Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann\u2010Sofi","family":"Duberg","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Faculty of Medicine and Health \u00d6rebro University \u00d6rebro Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nele","family":"Brusselaers","sequence":"additional","affiliation":[{"name":"Centre for Translational Microbiome Research (CTMR) Department of Microbiology Tumor and Cell biology (MTC) Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soo","family":"Aleman","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Karolinska University Hospital Stockholm Sweden"},{"name":"Department of Medicine Huddinge Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,7,28]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1713263"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12985-017-0845-y"},{"key":"e_1_2_10_4_1","first-page":"23","article-title":"The global prevalence of hepatitis D virus infection: systematic review and meta\u2010analysis","volume":"23","author":"Stockdale AJ","year":"2020","journal-title":"J Hepatol"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiz633"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14357"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/155.5.931"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840060415"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-98-4-437"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2009.01.052"},{"key":"e_1_2_10_11_1","unstructured":"Agents Classified by the IARC Monographs Volumes 1\u2013125 \u2013 IARC Monographs on the Identification of Carcinogenic Hazards to Humans.https:\/\/monographs.iarc.fr\/agents\u2010classified\u2010by\u2010the\u2010iarc\/. 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