{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T16:02:17Z","timestamp":1765382537207,"version":"build-2065373602"},"reference-count":61,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T00:00:00Z","timestamp":1726185600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy of Iasi","award":["1715\/2017"],"award-info":[{"award-number":["1715\/2017"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>The hepatitis D virus (HDV) superinfection of individuals with chronic hepatitis B virus (HBV) infection causes severe liver damage and the poorest long-term prognosis among viral hepatitis. This is attributed to the unique pathogenic mechanisms of HDV characterized by a direct cytopathic effect on hepatocytes and a significant impairment of the host immune response. The HDV genotype largely influences the extent of the pathogenic mechanisms with consequences on disease progression towards cirrhosis, liver decompensation, or hepatocellular carcinoma. In this context, identifying the circulating HDV genotypes in European regions with high prevalence, such as Romania, is crucial for effectively managing the long-term liver health. Here, we report the first comprehensive HDV study in Romania that clinically characterizes 82 patients and performs HDV genotyping by combining the nested-PCR reaction with sequencing analysis in 49 samples with an HDV-RNA load higher than 5000 IU\/mL. While all isolates in our study belong to the HDV-1 genotype, the phylogenetic analysis based on sequence data from GenBank reveals the presence of the following potential three groups: (i) Italy and France; (ii) Spain; and (iii) Turkey, Iran, Pakistan, and Germany. This broad clustering highlights the recent surge in migration to and from Western Europe and the Middle East. Equally important, no differences in viral markers, clinical and paraclinical parameters, or treatment options were observed between these identified clusters. Nevertheless, this study considerably advances the understanding of hepatitis D epidemiology and clinical aspects in Romania.<\/jats:p>","DOI":"10.3390\/pathogens13090793","type":"journal-article","created":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T03:03:37Z","timestamp":1726196617000},"page":"793","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Molecular Epidemiology of Hepatitis D Virus in the North-East Region of Romania"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0491-6685","authenticated-orcid":false,"given":"Laura Iulia","family":"Grecu","sequence":"first","affiliation":[{"name":"Department of Preventive Medicine and Interdisciplinarity Microbiology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Emerging Viral Diseases, \u201cStefan S. Nicolau\u201d Institute of Virology, 030304 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2802-5993","authenticated-orcid":false,"given":"Mariana","family":"Pavel-Tanasa","sequence":"additional","affiliation":[{"name":"Department of Immunology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Laboratory of Immunology, St. Spiridon County Clinical Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4479-655X","authenticated-orcid":false,"given":"Lilia","family":"Matei","sequence":"additional","affiliation":[{"name":"Department of Cellular and Molecular Pathology, \u201cStefan S. Nicolau\u201d Institute of Virology, 030304 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5954-3312","authenticated-orcid":false,"given":"Camelia","family":"Sultana","sequence":"additional","affiliation":[{"name":"Department of Emerging Viral Diseases, \u201cStefan S. Nicolau\u201d Institute of Virology, 030304 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2492-6073","authenticated-orcid":false,"given":"Simona Maria","family":"Ruta","sequence":"additional","affiliation":[{"name":"Department of Emerging Viral Diseases, \u201cStefan S. Nicolau\u201d Institute of Virology, 030304 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Razvan Ioan","family":"Grecu","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Interdisciplinarity Microbiology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Diaverum Romania, 011857 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1811-7923","authenticated-orcid":false,"given":"Ramona Gabriela","family":"Ursu","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Interdisciplinarity Microbiology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Microbiology Department, Gynecology and Obstetrics Hospital-Cuza Voda, 700038 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5403-2265","authenticated-orcid":false,"given":"Petru","family":"Cianga","sequence":"additional","affiliation":[{"name":"Department of Immunology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Laboratory of Immunology, St. Spiridon County Clinical Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2592-3982","authenticated-orcid":false,"given":"Luminita Smaranda","family":"Iancu","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Interdisciplinarity Microbiology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.jhep.2007.11.011","article-title":"Natural history of chronic hepatitis B: Special emphasis on disease progression and prognostic factors","volume":"48","author":"Giovanna","year":"2008","journal-title":"J. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"a02150","DOI":"10.1101\/cshperspect.a021550","article-title":"Hepatitis D Virus Coinfection and Superinfection","volume":"4","author":"Negro","year":"2014","journal-title":"Cold Spring Harb. Perspect. 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