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We analysed data from a large HIV cohort collaboration to characterize HDV epidemiological trends across Europe, as well as its impact on clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All PLWH with a positive hepatitis B surface antigen (HBsAg) in the Swiss HIV Cohort Study and EuroSIDA between 1988 and 2019 were tested for anti\u2010HDV antibodies and, if positive, for HDV RNA. Demographic and clinical characteristics at initiation of antiretroviral therapy were compared between HDV\u2010positive and HDV\u2010negative individuals using descriptive statistics. The associations between HDV infection and overall mortality, liver\u2010related mortality as well as hepatocellular carcinoma (HCC) were assessed using cumulative incidence plots and cause\u2010specific multivariable Cox regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 2793 HBsAg\u2010positive participants, 1556 (56%) had stored serum available and were included. The prevalence of HDV coinfection was 15.2% (237\/1556, 95% confidence interval [CI]: 13.5%\u201317.1%) and 66% (132\/200) of HDV\u2010positive individuals had active HDV replication. Among persons who inject drugs (PWID), the prevalence of HDV coinfection was 50.5% (182\/360, 95% CI: 45.3%\u201355.7%), with similar estimates across Europe, compared to 4.7% (52\/1109, 95% CI: 3.5%\u20135.9%) among other participants. During a median follow\u2010up of 10.8\u2009years (interquartile range 5.6\u201317.8), 82 (34.6%) HDV\u2010positive and 265 (20.1%) HDV\u2010negative individuals died. 41.5% (34\/82) of deaths were liver\u2010related in HDV\u2010positive individuals compared to 17.7% (47\/265) in HDV\u2010negative individuals. HDV infection was associated with overall mortality (adjusted hazard ratio 1.6; 95% CI 1.2\u20132.1), liver\u2010related death (2.9, 1.6\u20135.0) and HCC (6.3, 2.5\u201316.0).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We found a very high prevalence of hepatitis delta among PWID across Europe. Among PLWH who do not inject drugs, the prevalence was similar to that reported from populations without HIV. HDV coinfection was associated with liver\u2010related mortality and HCC incidence.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.15519","type":"journal-article","created":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T15:50:10Z","timestamp":1673365810000},"page":"819-828","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Hepatitis delta infection among persons living with HIV in Europe"],"prefix":"10.1111","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9346-5146","authenticated-orcid":false,"given":"Charles","family":"B\u00e9guelin","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Bern University Hospital Inselspital, University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Atkinson","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Bern University Hospital Inselspital, 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Faculty of Medicine University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huldrych F.","family":"G\u00fcnthard","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Hospital Epidemiology University Hospital Zurich  Zurich Switzerland"},{"name":"Institute of Medical Virology University of Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen K.","family":"Rockstroh","sequence":"additional","affiliation":[{"name":"Department of Medicine I University Hospital Bonn  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Mocroft","sequence":"additional","affiliation":[{"name":"Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME) Institute for Global Health, UCL  London UK"},{"name":"Rigshospitalet, University of Copenhagen, Centre of Excellence for Health, Immunity and Infections (CHIP)  Copenhagen 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