Investigation of Seroprevalence and Risk Factors of Hepatitis D in Provinces with Common Borders of Iran and Afghanistan

Background: Hepatitis D virus (HDV) relies on hepatitis B surface antigen (HBsAg) for infection, often causing more severe disease than hepatitis B virus (HBV) alone. While HDV seroprevalence is well-documented in regions like the Mediterranean and Middle East, limited data exist for Afghanistan, where migration patterns may influence prevalence. Objectives: This study investigated HDV seroprevalence among HBV-infected individuals in the border provinces of eastern Iran and western Afghanistan. Methods: A cross-sectional study was conducted on 350 HBsAg-positive patients from three Iranian provinces (Razavi Khorasan, South Khorasan, Sistan, and Baluchestan) and three Afghan provinces (Herat, Farah, Nimroz). Risk factor data were collected via questionnaire, and serum samples were tested for anti-HDV antibodies. The HDV seroprevalence was analyzed across various demographic categories, and the relationship between categorical variables (age, gender, marital status, living status) and HDV status was assessed using the chi-square or Fisher's exact test. Results: Of the participants, 57.14% were men, and 42.86% were women. HDV antibodies were detected in 37 patients (10.57%). Seroprevalence in Iranian provinces was 4.6% in Mashhad, 2.7% in Birjand, and 13% in Zahedan, compared to 17.3% in Afghanistan’s border provinces. No significant differences in age, gender, or marital status were observed between HDV-positive and HDV-negative groups (P > 0.05). However, a significant difference was observed between the place of residence in the HDV-positive and HDV-negative groups (P = 0.004). Conclusions: The HDV seroprevalence is significantly higher in the western provinces of Afghanistan than in eastern Iran, underscoring the importance of routine HDV screening among HBV-infected patients in these regions to improve disease management and public health outcomes.