The global epidemiology of hepatitis D is changing with the widespread implementation of
vaccination against hepatitis B. In high-income countries that achieved optimal control of
HBV, the epidemiology of hepatitis D is dual, consisting of an ageing cohort of domestic
patients with advanced liver fibrosis who represent the end stage of the natural history of
HDV, and of a younger generation of immigrants from endemic countries who account for
the majority of new infections. As observed in Europe in the 1980s, the distinctive clinical …