male health practice, in the absence of universal precautions for infection control. In the community, it is associated with pregnancy and cultural practices such as tattoos and circumcision.

It is estimated that over 20 million people are infected with HDV. The prevalence varies greatly from one region to another. The highest prevalence rates have been reported in the Mediterranean basin, the Middle East, central and northern Asia, sub-Saharan Africa, and South America \[[@B15], [@B16]\]. At least eight HDV genotypes have been described. Genotype I is the most prevalent and has been found in Europe, the Middle East, North America, and North Africa. Genotype II has been found in the Far East, Genotype III has been found in South America, and Genotypes IV--VIII have been found in Africa \[[@B17], [@B18]\].showed that the prevalence of HCV in rural areas is higher than in urban cities, particularly in Egypt and Sudan \[[@B70]\].

HDV RNA was measured in participants positive for anti-HDV in only nine cohort studies, in which a total of 416 participants were tested. The prevalence of HDVRNA was consistent in most of the studies reported. In Egypt, Tunisia, Sudan, and Libya, HDVRNA prevalence was similar in the different subpopulations studied, including out-patients, blood donors, and pregnant women; it ranged from 25 to 30% but reached 69% in Mauritania. However, no data have been reported from Algeria and Morocco.

The prevalence of HDV in liver disease patients and in hemodialysis patients in North Africa was three to four times higher than in the general population and in blood donors, particularly