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Debsikréo N, Dehainsala M, Debsikréo O, Leye N, LO G, Dia A, Flore MNB, Diaw NA, Diouf ND, Otchere ID, Toyé RM, Chemin I, Moussa AM, Toure-Kane NC, Lunel-Fabiani F. Prevalence and molecular characterization of hepatitis delta virus infection among hepatitis B virus surface antigen positive students and pregnant women in N'djamena, Chad. IJID REGIONS 2025; 14:100560. [PMID: 39895833 PMCID: PMC11786080 DOI: 10.1016/j.ijregi.2024.100560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Revised: 12/22/2024] [Accepted: 12/24/2024] [Indexed: 02/02/2025]
Abstract
OBJECTIVES This study sought to determine the prevalence of hepatitis B virus (HBV)-hepatitis D virus (HDV) co-infection and to characterize isolates of both viruses in a Chadian population of HBV surface antigen (HBsAg)-positive pregnant women and students. METHODS This was a cross-sectional retrospective study using archived samples from pregnant women and students in N'djamena who had been systematically screened for HBsAg between April and August 2021. HBsAg-positive samples were tested for the presence of HDV antibodies (Ab) and were screened for the presence of both HBV and HDV (in anti-HDV Ab-positive samples) viral load estimations. Genome sequencing of the viruses was used for both genotyping and phylogenetic analysis. RESULTS A total of 94 participants were included in this study. The mean age was 24 ± 4.89 years (range: 18-42 years). Anti-HDV Ab were found in 9.57% (9/94) of the participants. The prevalence of anti-HDV Ab positivity among students (6.45% [4/62]) was lower than the 15.63% (5/32) observed among pregnant women. HDV-RNA was detected in 7/9 (77.77%) confirmed anti-HDV-positive participants. Most HDV-RN-positive participants had very low HBV DNA viral loads. All HBV sequences belonged to genotype E and all HDV sequences to genotype 1. CONCLUSIONS Hepatitis D is a potential public health challenge in Chad, which requires active surveillance and public education in the country for proper control. This surveillance should be supported with mass immunization against HBV.
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Affiliation(s)
- Nalda Debsikréo
- Cheikh Anta Diop University, Dakar, Senegal
- Institut de Recherche en Santé, de Surveillance Épidémiologique et de Formation, Dakar, Sénégal
- University of N'Djamena, N'Djamena, Chad
| | | | - Odan Debsikréo
- University of Félix Houphouët Boigny Abidjan, Abidjan, Côte d'ivore
| | - Nafissatou Leye
- Institut de Recherche en Santé, de Surveillance Épidémiologique et de Formation, Dakar, Sénégal
| | - Gora LO
- Institut de Recherche en Santé, de Surveillance Épidémiologique et de Formation, Dakar, Sénégal
| | - Aminata Dia
- Institut de Recherche en Santé, de Surveillance Épidémiologique et de Formation, Dakar, Sénégal
| | | | - Ndeye Aminata Diaw
- Institut de Recherche en Santé, de Surveillance Épidémiologique et de Formation, Dakar, Sénégal
| | - Ndeye Dieynaba Diouf
- Institut de Recherche en Santé, de Surveillance Épidémiologique et de Formation, Dakar, Sénégal
| | - Isaac Darko Otchere
- Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, Fajara, the Gambia
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Rayana Maryse Toyé
- Centre de Recherche en Cancérologie de Lyon INSERM U1052, CNRS UMR5286, Université de Lyon, Lyon, France
| | - Isabelle Chemin
- Centre de Recherche en Cancérologie de Lyon INSERM U1052, CNRS UMR5286, Université de Lyon, Lyon, France
| | - Ali Mahamat Moussa
- University of N'Djamena, N'Djamena, Chad
- Centre Hospitalier Universitaire la Référence, N'Djamena, Chad
| | - Ndèye Coumba Toure-Kane
- Institut de Recherche en Santé, de Surveillance Épidémiologique et de Formation, Dakar, Sénégal
| | - Françoise Lunel-Fabiani
- Centre Hospitalier Universitaire Angers, BAT IBS-4 rue Larrey-49000 ANGERS, Laboratoire HIFIH, UFR Santé département Médecine, SFR 4208-UPRES EA3859, Université d'Angers, Angers Cedex, France
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Le Guillou-Guillemette H, Pivert A, ElBara A, Vall M, Sang CNW, Veillon P, Ducancelle A, Bollahi MA, Mohamed MS, Lunel-Fabiani F. Prevalence, clinical and virological characteristics and short-term prognosis of hepatitis delta infection among patients with HIV/HBV in Nouakchott, Mauritania. J Viral Hepat 2024; 31:457-465. [PMID: 38771311 DOI: 10.1111/jvh.13950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024]
Abstract
Patients living with HIV infection (PLWH) are at risk of acquiring HBV and HDV. The present study aimed to determine the prevalence and characteristics of HIV-HDV-HBV tri-infection in comparison with HIV-HBV coinfection and to estimate severities and outcomes of associated liver diseases in Mauritanian PLWH. Two-hundred-ninety-two consecutive HBsAg-positive PLWH were included (mean age: 37 years). Clinical data were recorded. Anti-HDV antibodies, HBV and HDV viral loads (VLs) and genotype were determined. APRI, FIB-4 and FibroScan were performed to evaluate the severity of liver disease. The anti-HDV antibodies prevalence was 37% and HDV RNA was positive in 40.7% of patients. Genetic diversities were found with HDV genotype 1 (93%) and HBV genotypes D (42.5%) and E (38%). The HBV VL was detectable in 108 patients at inclusion, and mutations associated with HBV resistance were found in 20. For almost all variables studied, including FIB-4 and APRI scores, no significant differences were found between anti-HDV-Ab positive or negative patients. FibroScan examination, which was performed in 110 patients at end-of-follow-up showed higher, but NS values, in HDV positive patients. After a mean follow-up of 24.55 ± 8.01 months (n = 217 patients), a highly significant worsening of APRI and FIB-4 scores was found. Moreover, patients with HDV showed more severe liver disease progression despite an efficient therapy. In a substantial Mauritanian cohort of relatively young PLWH, we found high HDV prevalence and worsening liver disease. In high-risk countries, screening for HDV and providing appropriate follow-up and treatments are warranted in PLWH.
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Affiliation(s)
- Hélène Le Guillou-Guillemette
- Virology Department, Angers University Hospital, Angers, France
- HIFIH Laboratory EA 3859, Angers University, Angers, France
| | - Adeline Pivert
- Virology Department, Angers University Hospital, Angers, France
- HIFIH Laboratory EA 3859, Angers University, Angers, France
| | | | | | | | - Pascal Veillon
- Virology Department, Angers University Hospital, Angers, France
| | - Alexandra Ducancelle
- Virology Department, Angers University Hospital, Angers, France
- HIFIH Laboratory EA 3859, Angers University, Angers, France
| | | | | | - Françoise Lunel-Fabiani
- Virology Department, Angers University Hospital, Angers, France
- HIFIH Laboratory EA 3859, Angers University, Angers, France
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3
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Abdul Majeed N, Zehnder B, Koh C, Heller T, Urban S. Hepatitis delta: Epidemiology to recent advances in therapeutic agents. Hepatology 2023; 78:1306-1321. [PMID: 36738087 DOI: 10.1097/hep.0000000000000331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/19/2022] [Indexed: 02/05/2023]
Abstract
Hepatitis D virus (HDV) was first described in 1977 and is dependent on the presence of hepatitis B surface antigen (HBsAg) for its entry into cells and on the human host for replication. Due to the envelopment with the hepatitis B virus (HBV) envelope, early phases of HDV entry resemble HBV infection. Unlike HBV, HDV activates innate immune responses. The global prevalence of HDV is estimated to be about 5% of HBsAg positive individuals. However, recent studies have described a wide range of prevalence between 12 to 72 million individuals. Infection can occur as super-infection or co-infection. The diagnosis of active HDV infection involves screening with anti HDV antibodies followed by quantitative PCR testing for HDV RNA in those who are HBsAg positive. The diagnostic studies have evolved over the years improving the validity and reliability of the tests performed. HDV infection is considered the most severe form of viral hepatitis and the HDV genotype may influence the disease course. There are eight major HDV genotypes with prevalence varying by geographic region. HDV treatment has been challenging as HDV strongly depends on the host cell for replication and provides few, if any viral targets. Better understanding of HDV virology has led to the development of several therapeutic agents currently being studied in different phase II and III clinical trials. There is increasing promise of effective therapies that will ameliorate the course of this devastating disease.
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Affiliation(s)
- Nehna Abdul Majeed
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Benno Zehnder
- Department of Infectious Diseases, Molecular Virology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christopher Koh
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Theo Heller
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Stephan Urban
- Department of Infectious Diseases, Molecular Virology, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Infection Research (DZIF) - Heidelberg Partner Site, Heidelberg, Germany
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4
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Kamal H, Aleman S. Natural history of untreated HDV patients: Always a progressive disease? Liver Int 2023; 43 Suppl 1:5-21. [PMID: 36308026 DOI: 10.1111/liv.15467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 02/13/2023]
Abstract
A severe course has been described in early studies on chronic hepatitis D (CHD), with faster pace towards liver cirrhosis with subsequent high liver-related morbidity and mortality in the majority of patients. Earlier studies have included risk groups as people using intravenous drugs (PWID) or those with multiple co-morbidities. During the last decade, the epidemiological landscape of CHD has changed with domestic cases decreasing while increasing cases of CHD consisting of younger persons immigrating from endemic regions to low-endemic regions. Recently, further insights into the spectrum of the disease with an indolent disease course in a substantial proportion of persons with CHD have been gained. At diagnosis, ≥30%-50% had already established liver cirrhosis. Older age, liver cirrhosis, co-infection with HIV and lack of interferon (IFN) therapy are the main predictors of worse clinical outcome. The newly introduced and upcoming antivirals against CHD are highly anticipated, considering the historically low virological response rates to antiviral therapy. Further knowledge is needed to fully comprehend the natural course and the spectrum of this severe form of viral hepatitis. This is also to be able to evaluate the long-term effects of the new antivirals on disease progression.
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Affiliation(s)
- Habiba Kamal
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Infectious Diseases, Karolinska Institute, Stockholm, Sweden
| | - Soo Aleman
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Infectious Diseases, Karolinska Institute, Stockholm, Sweden
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5
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Elazar M, Glenn JS. Combination of Novel Therapies for HDV. Viruses 2022; 14:v14020268. [PMID: 35215860 PMCID: PMC8877160 DOI: 10.3390/v14020268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/16/2022] [Accepted: 01/21/2022] [Indexed: 11/16/2022] Open
Abstract
Treatment options for HDV have been limited to interferon alfa-based therapies with its poor efficacy to side effects ratio. Several novel therapies have now advanced into the clinic. As they each have a different mechanism of action, there is the potential for combination therapy. Here we review how studying the HDV life cycle has led to the development of these novel therapies, the key developments leading to, and the details of, the first combination study of novel anti-HDV therapies, and suggest what additional combinations of novel therapies can be anticipated as we enter this exciting new area of HDV treatments.
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Affiliation(s)
- Menashe Elazar
- Division of Gastroenterology and Hepatology, Department of Medicine-Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Jeffrey S. Glenn
- Division of Gastroenterology and Hepatology, Department of Medicine-Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA;
- Palo Alto Veterans Administration, Palo Alto, CA 94305, USA
- Correspondence:
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Sagnelli C, Pisaturo M, Curatolo C, Codella AV, Coppola N, Sagnelli E. Hepatitis B virus/hepatitis D virus epidemiology: Changes over time and possible future influence of the SARS-CoV-2 pandemic. World J Gastroenterol 2021; 27:7271-7284. [PMID: 34876788 PMCID: PMC8611207 DOI: 10.3748/wjg.v27.i42.7271] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/20/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
Hepatitis D virus (HDV) is a defective liver-tropic virus that needs the helper function of hepatitis B virus (HBV) to infect humans and replicate. HDV is transmitted sexually or by a parenteral route, in co-infection with HBV or by super-infection in HBV chronic carriers. HDV infection causes acute hepatitis that may progress to a fulminant form (7%-14% by super-infection and 2%-3% by HBV/HDV co-infection) or to chronic hepatitis (90% by HDV super-infection and 2%-5% by HBV/HDV co-infection), frequently and rapidly progressing to cirrhosis or hepatocellular carcinoma (HCC). Peg-interferon alfa the only recommended therapy, clears HDV in only 10%-20% of cases and, consequently, new treatment strategies are being explored. HDV endemicity progressively decreased over the 50 years from the identification of the virus, due to improved population lifestyles and economic levels, to the use of HBV nuclei(t)side analogues to suppress HBV replication and to the application of universal HBV vaccination programs. Further changes are expected during the severe acute respiratory syndrome coronavirus-2 pandemic, unfortunately towards increased endemicity due to the focus of healthcare towards coronavirus disease 2019 and the consequently lower possibility of screening and access to treatments, lower care for patients with severe liver diseases and a reduced impulse to the HBV vaccination policy.
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Affiliation(s)
- Caterina Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples 80131, Italy
| | - Mariantonietta Pisaturo
- Department of Mental Health and Public Medicine, University of Campania, Naples 80135, Italy
| | - Caterina Curatolo
- Department of Mental Health and Public Medicine, University of Campania, Naples 80135, Italy
| | - Alessio Vinicio Codella
- Department of Mental Health and Public Medicine, University of Campania, Naples 80135, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, University of Campania, Naples 80135, Italy
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples 80131, Italy
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From national HBV and HDV screenings to vaccination and treatment in healthcare workers: The Mauritanian pilot study. Vaccine 2021; 39:2274-2279. [PMID: 33752951 DOI: 10.1016/j.vaccine.2021.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 02/03/2021] [Accepted: 03/03/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Hepatitis B and D infections are highly endemic in Mauritania, with prevalences ranging from 10 to 20%. With the present prospective transversal pilot study, we aimed to evaluate the prevalences of HBV, HCV, and HDV infections in healthcare workers (HCWs), and offer treatment or vaccination as required. METHODS At inclusion, each HCW was screened for anti-HBc Ab (followed by HBsAg assay when positive). Additional biological analyses were performed for HBsAg + cases. Depending on the results, HBV vaccination or anti-viral treatment was offered. RESULTS A total of 3,857 HCWs were included, of whom 1,363 tested negative for anti-HBc Ab and received full vaccination. Of the 2,494 HCWs who were positive for anti-HBc Ab, 1,246 were positive for anti-HBs Ab and 418 were positive for HBsAg. Three HCWs were positive for HBeAg; 66 and 18 had HBV DNA levels respectively > 2,000 and > 20,000 IU/mL; and 48 were positive for anti-HDV Ab among whom 10 were positive for HDV RNA. HCV prevalence was 0.5%. Only seven HCWs fulfilled the criteria for treatment and five of them were treated. CONCLUSION Few HCWs in Mauritania are immunised against HBV. The prevalences of anti-HBc Ab and HBsAg observed in this work were similar to those observed in our earlier works, whereas prevalence of active HDV infection was less high. HBV and HDV infections are a serious health concern in Mauritania. New recommendations developed in accordance with WHO guidelines should include mandatory HBV screening and immunisation for HCWs.
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8
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Opaleye OO, Akanbi OA, Osundare FA, Wang B, Adesina O, Oluremi AS, Sunday ST, Akindele AA, Klink P, Bock CT. Prevalence and characteristics of hepatitis B and D virus infections among HIV-positive individuals in Southwestern Nigeria. Virol J 2021; 18:20. [PMID: 33446224 PMCID: PMC7809746 DOI: 10.1186/s12985-021-01493-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/08/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Coinfections of HIV-positive individuals with Hepatitis B and D virus (HBV and HDV) are common and can be associated with rapid liver damage. Several antiretroviral drugs for HIV exhibit anti-HBV effect; however, the selection of HBV drug resistance mutations (DRMs) in individuals under HIV antiretroviral therapy (ART) has been reported but rarely in Nigeria. In this study the HBV/HDV prevalence and HBV DRMs in HIV-positive individuals in Southwestern Nigeria were assessed. METHODS Plasma samples collected from 310 HIV-positive individuals including 295 ART-experienced and 15 ART-naïve persons attending the HIV clinic in three south-western states of Nigeria between June 2017 and August 2017 were analysed by ELISA for HBsAg and anti-HDV. The presence of HDV RNA and HBV DNA was analysed by (RT)-PCR followed by sequencing and phylogenetic analyses for genotyping. The HBV reverse transcription (RT) region was amplified and sequenced for the analysis of drug resistance mutations. RESULTS Overall, 16.1% (n = 50/310) of the HIV-positive individuals were positive for HBsAg, most of which were ART-experienced (94.0%; n = 47/50). From the 50 HBsAg-positive samples, 72.0% (n = 36/50) were positive for HBV DNA and 16.0% (n = 8/50) had detectable HDV RNA while 5.6% (n = 2/36) of the HBV-DNA positive samples had anti-HDV total antibodies. Sequences were available for 31/36 of the HBV DNA-positive and 3/8 HDV RNA-positive samples. HBV DNA-positive samples were characterised as HBV genotype E infections exclusively, while HDV genotype 1 was detected in the HDV RNA-positive samples. HBV DRMs V173L, L180M, S202I and M204V/I, which are associated with lamivudine resistance, were detected in 32.2% (n = 10/31) of the HBV DNA-positive samples. Most of these mutations (90.0%; n = 9/10) were present in the ART-experienced cohort. CONCLUSIONS This study indicates that HBV/HDV coinfections are common in HIV-positive individuals under ART in Nigeria. Furthermore, a high proportion of HBV DRMs which potentially compromise future treatment options were detected, underscoring the need for HBV screening prior to starting ART. Further studies should be performed to monitor a possible increase in the spread of HDV among populations at risk of HIV and HBV infections.
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Affiliation(s)
- Oluyinka Oladele Opaleye
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
| | - Olusola Anuoluwapo Akanbi
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - Folakemi Abiodun Osundare
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - Bo Wang
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - Olufisayo Adesina
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
- Department of Microbiology, Obafemi Awolowo University, Ile Ife, Osun State, Nigeria
| | - Adeolu Sunday Oluremi
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
| | - Sola Thomas Sunday
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
| | - Abiodun Akeem Akindele
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
| | - Patrycja Klink
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - C Thomas Bock
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany.
- Institute of Tropical Medicine, University of Tuebingen, Tuebingen, Germany.
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Ramachandran K, Agarwal R, Sharma MK, Bhatia V, Gupta E. Prevalence of Hepatitis Delta Virus Infection among Hepatitis B Virus-Infected and Exposed Patients. J Glob Infect Dis 2020; 12:197-201. [PMID: 33888957 PMCID: PMC8045544 DOI: 10.4103/jgid.jgid_137_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/16/2019] [Accepted: 01/20/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Hepatitis delta virus (HDV) infection is a cause of coinfection and superinfection among hepatitis B virus (HBV)-infected patients. The global prevalence of HDV may vary drastically depending on the geographical location. In India, serological techniques form the basis for the determination of HDV prevalence in majority of the studies with very limited literature based on molecular techniques. In addition, sparse data on HDV infection among HBV-exposed group, i.e., patients with total antibodies to core antigen (anti-hepatitis B core [HBc]) positive and negative hepatitis B surface antigen (HBsAg), are available. Objective: This study was aimed to determine the prevalence of HDV in both HBV-infected and HBV-exposed groups, utilizing both serological and molecular methods. Settings and Design: This was a retrospective cross-sectional study conducted from January till June 2018 where samples of 142 patients were retrieved and were categorized into two groups: Group A included patients with both HBsAg and anti-HBc positivity (n = 120/142 [85%]), i.e., confirmed HBV infection, and Group B included patients with anti-HBc positivity and HBsAg negativity (n = 22/142 [15%]), i.e., exposed to HBV. Materials and Methods: All the specimens were retrieved from −80°C and were tested for anti-HDV immunoglobulin (Ig) M (IgM), anti-HDV IgG, and HDV RNA. Results: HDV infection was observed in only one patient in Group A and none in Group B, making an overall prevalence of 0.78% (95% confidence interval = 0.02%–3.9%). The infected patient was reactive for both IgM and IgG with a viral load of 2log10IU/ml. Conclusion: The present study provides evidence that HDV infection is very low(0.78%) in this part of India. However further prospective studies with larger sample size are warranted.
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Affiliation(s)
- Krithiga Ramachandran
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Reshu Agarwal
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Manoj Kumar Sharma
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vikram Bhatia
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ekta Gupta
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India
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10
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Tan M, Bhadoria AS, Cui F, Tan A, Van Holten J, Easterbrook P, Ford N, Han Q, Lu Y, Bulterys M, Hutin Y. Estimating the proportion of people with chronic hepatitis B virus infection eligible for hepatitis B antiviral treatment worldwide: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020; 6:106-119. [PMID: 33197397 PMCID: PMC7801814 DOI: 10.1016/s2468-1253(20)30307-1] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/08/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND In 2016, of the estimated 257 million people living with chronic hepatitis B virus (HBV) infection worldwide, only a small proportion was diagnosed and treated. The insufficiency of information on the proportion of people infected with HBV who are eligible for treatment limits the interpretation of global treatment coverage. We aimed to estimate the proportion of people with chronic HBV infection who were eligible for antiviral treatment worldwide, based on the WHO 2015 guidelines. METHODS In this systematic review and meta-analysis, we searched Medline, EMBASE, and the Cochrane databases from Jan 1, 2007, to Jan 31, 2018, for studies describing HBsAg-positive people in the population or health-care facilities. We extracted information from published studies using a standardised form to estimate the frequency of cirrhosis, abnormal alanine aminotransferase (ALT), HBV DNA exceeding 2000 IU/mL or 20 000 IU/mL, presence of HBeAg, and eligibility for treatment as per WHO and other guidelines as reported in the studies. We pooled proportions through meta-analysis with random effects. The study was registered with PROSPERO, CRD42020132345. FINDINGS Of the 13 497 studies, 162 were eligible and included in our analysis. These studies included 145 789 participants. The pooled estimate of the proportion of cirrhosis was 9% (95% CI 8-10), ranging from 6% (4-8) in community settings to 10% (9-11) in clinic settings. Examining the proportion of participants who had characteristics used to determine eligibility in the WHO guidelines, 1750 (10·1%) of 17 394 had HBV DNA exceeding 20 000 IU/mL, and 20 425 (30·8%) of 66 235 had ALT above the upper limit of normal. 32 studies reported eligibility for treatment according to WHO or any other guidelines, with a pooled estimate of eligibility at 19% (95% CI 18-20), ranging from 12% (6-18) for studies in community settings to 25% (19-30) in clinic settings. INTERPRETATION Many studies described people with HBV infection, but few reported information in a way that allowed assessment of eligibility for treatment. Although about one in ten of the 257 million people with HBV infection (26 million) might be in urgent need of treatment because of cirrhosis, a larger proportion (12-25%) is eligible for treatment in accordance with different guidelines. Future studies describing people with HBV infection should report on treatment eligibility, according to broadly agreed definitions. FUNDING WHO and US Centers for Disease Control and Prevention.
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Affiliation(s)
- Mingjuan Tan
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland; Department of Medicine, National University Health System, Singapore
| | - Ajeet S Bhadoria
- All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Fuqiang Cui
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland
| | | | - Judith Van Holten
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland
| | | | - Nathan Ford
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland
| | - Qin Han
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland
| | - Ying Lu
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland
| | - Marc Bulterys
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland
| | - Yvan Hutin
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland.
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Scarponi CFDO, Silva RDND, Souza Filho JAD, Guerra MRL, Pedrosa MAF, Mol MPG. Hepatitis Delta Prevalence in South America: A Systematic Review and Meta-Analysis. Rev Soc Bras Med Trop 2019; 52:e20180289. [PMID: 30698197 DOI: 10.1590/0037-8682-0289-2018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/18/2018] [Indexed: 02/06/2023] Open
Abstract
Hepatitis delta virus (HDV) has been associated with acute or chronic hepatitis in Latin America, but there is no prevalence study covering South American countries. This meta-analysis aimed to estimate anti-HDV prevalence through a systematic review of published articles in English, Portuguese and Spanish until December 2017. Searches were conducted in Health Virtual Library, Capes, Lilacs, PubMed, and SciELO, according to defined criteria regarding participant selection and geographical setting. Study quality was assessed using the GRADE guidelines. Pooled anti-HDV prevalence was calculated using the DerSimonian-Laird random-effects model with Freeman-Tukey double arcsine transformation. Out of the 405 identified articles, only 31 met the eligibility criteria for inclusion in the meta-analysis. In South America, pooled anti-HDV prevalence among hepatitis B virus carriers was 22.37% (95% confidence interval: 13.72-32.26), though it appeared less frequently in some countries and populations, according to the data collection date. The findings indicated significant successive reductions in anti-HDV prevalence over thirty years. However, there was a scarcity of HDV epidemiological studies outside the Amazon Basin, notably in the Southwest continent and absence of target population standardization. There was a high HDV prevalence in South American countries, despite differences in methodological characteristics and outcomes, highlighting a drastic decline in the last decades. Future studies should identify HDV prevalence estimates in other regions of the continent and identify risk factors.
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Affiliation(s)
| | | | | | | | | | - Marcos Paulo Gomes Mol
- Diretoria de Pesquisa e Desenvolvimento. Fundação Ezequiel Dias, Belo Horizonte, MG, Brasil
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12
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Jackson C, Gunson RN, Bradley-Stewart A, Bennett S, Black H, Kennedy N, Bell DJ. Epidemiology and patient characteristics of hepatitis D virus infection in the West of Scotland 2011-2016. J Viral Hepat 2018; 25:1395-1396. [PMID: 29851188 DOI: 10.1111/jvh.12939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/25/2018] [Indexed: 12/31/2022]
Affiliation(s)
- C Jackson
- West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, Glasgow, UK.,The Brownlee Centre, Gartnavel General Hospital, Glasgow, UK
| | - R N Gunson
- West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, Glasgow, UK
| | - A Bradley-Stewart
- West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, Glasgow, UK
| | - S Bennett
- West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, Glasgow, UK
| | - H Black
- Monklands Hospital, Airdrie, UK
| | | | - D J Bell
- The Brownlee Centre, Gartnavel General Hospital, Glasgow, UK
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13
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Raad II, Chaftari AM, Torres HA, Ayoub EM, Narouz LI, Bartek J, Hachem R. Challenge of hepatitis C in Egypt and hepatitis B in Mauritania. World J Hepatol 2018; 10:549-557. [PMID: 30310533 PMCID: PMC6177572 DOI: 10.4254/wjh.v10.i9.549] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/14/2018] [Accepted: 05/30/2018] [Indexed: 02/06/2023] Open
Abstract
Egypt has one of the highest prevalence rates of hepatitis C virus (HCV) in the world, mostly with genotype 4 that is highly associated with severe fibrosis. As a consequence, hepatocellular carcinoma has become the leading cause of cancer in this country. Mauritania is a highly endemic area for hepatitis B virus (HBV). HBV and HCV could both be iatrogenically transmitted through infected blood products, infected needles, and medical equipment improperly sterilized. Adequate and efficient healthcare and public health measures with good surveillance programs, access for screening, prevention strategies, and successful treatment are needed to halt the spread of these diseases. Herein, we have reviewed the epidemiology, modes of transmission, predisposing factors, and novel treatment modalities of these viruses. We have proposed practices and interventions to decrease the risk of transmission of HCV and HBV in the affected countries, including strict adherence to standard precautions in the healthcare setting, rigorous education and training of patients and healthcare providers, universal screening of blood donors, use of safety-engineered devices, proper sterilization of medical equipment, hepatitis B vaccination, as well as effective direct-acting antiviral agents for the treatment of HCV.
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Affiliation(s)
- Issam I Raad
- Department of Infectious Diseases, Infection Control and Employee Health, the University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, United States
| | - Anne-Marie Chaftari
- Department of Infectious Diseases, Infection Control and Employee Health, the University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, United States.
| | - Harrys A Torres
- Department of Infectious Diseases, Infection Control and Employee Health, the University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, United States
| | - Ehab Mouris Ayoub
- Department of Internal Medicine, Harpur Memorial Hospital, Menouf 32951, Egypt
| | | | - Jalen Bartek
- Division of Internal Medicine, the University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, United States
| | - Ray Hachem
- Department of Infectious Diseases, Infection Control and Employee Health, the University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, United States
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14
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Daw MA, Daw AM, Sifennasr NEM, Draha AM, Daw AM, Daw AM, Ahmed MO, Mokhtar ES, El-Bouzedi A, Daw IM. The Epidemiology of Hepatitis D Virus in North Africa: A Systematic Review and Meta-Analysis. ScientificWorldJournal 2018; 2018:9312650. [PMID: 30356409 PMCID: PMC6178169 DOI: 10.1155/2018/9312650] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/25/2018] [Accepted: 08/27/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hepatitis D virus (HDV) infection has been considered a serious neglected pandemic, particularly in developing countries. The virus causes a more severe disease than mono infection with hepatitis B virus (HBV). The epidemiology of HDV is not well documented in North Africa, which is known to be endemic for HBV. In this study, we explored the prevalence of HDV infection and also attempted to identify factors associated with hepatitis D positive status among chronic hepatitis B patients in North Africa. METHODS The electronic databases PubMed, Embase, Scopus, Science Direct, Web of Science, and Google Scholar were comprehensively searched for all papers published between January 1, 1998, and December 31, 2017, using appropriate strategies containing all related keywords, including North Africa, names of countries in the region, and all permutations of hepatitis D virus. The estimated prevalence of HDV in North Africa was calculated as an average of the pooled infection prevalence in each country weighted by the ratio of the country's hepatitis D virus population to the study's sample size in the survey data analysis. FINDINGS A total of 312 studies were identified and 32 were included in this study, with a total sample of 4907 individuals screened for HDV. There was considerable variability in the prevalence estimates of HDV within the countries of the region. The overall prevalence of HDV in the general population of North Africa was 5·01% (95% CI: 1·25-8·27) and in liver disease patients it was 20.7% (95% CI:9.87-44.53). Genotype-1 was the most prominent genotype reported in five published studies. Ten studies reported on HDV RNA in participants who were seropositive for HDV, and four studies highlighted the impact of demographic factors (sex and age). No study showed the impact of risk factors on the prevalence of HDV in North Africa. INTERPRETATION This review provides a comprehensive assessment of the burden of HDV in Northern Africa. There were significant differences in seroprevalence, study population, and diagnostic testing between the countries in the region. The results presented here will alert health professionals to implement clear policies based on evidence to diminish the burden of HDV infection. Such measures may include but are not restricted to improving the laboratory diagnostic tests and initiating patient data registries and blood screening. Further epidemiological and research studies are needed to explore the risk factors, coinfections, and approaches to increase testing for HDV, particularly in high-risk subpopulations, such as intravenous drug users and immigrants, and to define the consequences of HDV infection in North Africa.
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Affiliation(s)
- Mohamed A. Daw
- Department of Medical Microbiology & Immunology, Faculty of Medicine, University of Tripoli, CC 82668, Tripoli, Libya
| | - Amina M. Daw
- Department of General Medicine, Faculty of Medicine, University of Tripoli, CC 82668, Tripoli, Libya
| | - Nadia E. M. Sifennasr
- Department of Medical Microbiology & Immunology, Faculty of Medicine, University of Tripoli, CC 82668, Tripoli, Libya
| | - Aisha M. Draha
- Department of Pharmacology, Faculty of Medicine, University of Tripoli, CC 82668, Tripoli, Libya
| | - Ahmed M. Daw
- Tripoli Medical Centre, Faculty of Medicine, University of Tripoli, CC 82668, Tripoli, Libya
| | - Ali M. Daw
- Tripoli Medical Centre, Faculty of Medicine, University of Tripoli, CC 82668, Tripoli, Libya
| | - Mohamed O. Ahmed
- Department of Microbiology and Parasitology, Faculty of Veterinary Medicine, University of Tripoli, CC 82668, Tripoli, Libya
| | - Ebtisam S. Mokhtar
- Department of Medical Microbiology & Immunology, Faculty of Medicine, University of Tripoli, CC 82668, Tripoli, Libya
| | - Abdallah El-Bouzedi
- Department of Laboratory Medicine, Faculty of Biotechnology, University of Tripoli, CC 82668, Tripoli, Libya
| | - Ibrahem M. Daw
- Department of Planning, Faculty of Engineering, University of Tripoli, CC 82668, Tripoli, Libya
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15
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Gourari S, Brichler S, Le Gal F, Abdou-Chekaraou M, Beloufa MA, Khelifa R, Djaballah H, Boufekane M, Nani A, Afredj N, Debzi N, Dény P, Gordien E, Tazir M. Hepatitis B virus and hepatitis delta virus subtypes circulating in Algeria and seroprevalence of HDV infection. J Med Virol 2018; 91:72-80. [PMID: 30168584 DOI: 10.1002/jmv.25301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 06/15/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Little is known about molecular characteristics of HBV strains circulating in Algeria and there are few data regarding HDV infection. OBJECTIVES The aim of this study is to describe the genetic diversity of HBV and HDV strains existing in Algeria and to determine the seroprevalence of HDV infection. STUDY DESIGN Plasma samples from 134 patients were analyzed by enzyme immunoassay method for HBV and HDV serological markers. Genotyping of HBV and HDV strains were performed using direct sequencing followed by phylogenetic analyses of the PreS1 and R0 region of the HBV and HDV genome respectively. RESULTS The PreS1 gene was successfully amplified in 119 patients (82 males and 37 females). Phylogenetic analysis of HBV strains revealed the presence of genotypes D (86.5%) and A2 (11.76%). The subgenotypes D are distributed as follows: HBV/D7 (43.5%), HBV/D3 (24.75%), HBV/D1 (16.8%) and HBV/D2 (14.85%). A recombinant between genotypes A, E and D was found. The seroprevalence of HDV infection among HBV carriers was less than 5.35%. Only one isolate of HDV genotype 1 was identified. CONCLUSIONS Our data indicate the predominance of HBV subgenotype D7 and a low prevalence of HDV infection.
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Affiliation(s)
- Samir Gourari
- Service de Microbiologie, CHU Mustapha, Algiers, Algeria
| | - Ségolène Brichler
- Service de Bactériologie, Virologie-Hygiène, Laboratoire associé au Centre National de Référence des Hépatites B, C et delta, Hôpital Avicenne, Bobigny, France
| | - Frédéric Le Gal
- Service de Bactériologie, Virologie-Hygiène, Laboratoire associé au Centre National de Référence des Hépatites B, C et delta, Hôpital Avicenne, Bobigny, France
| | - Mariama Abdou-Chekaraou
- Service de Bactériologie, Virologie-Hygiène, Laboratoire associé au Centre National de Référence des Hépatites B, C et delta, Hôpital Avicenne, Bobigny, France
| | | | - Rim Khelifa
- Service de Microbiologie, CHU Mustapha, Algiers, Algeria
| | | | | | | | - Nawel Afredj
- Service d'Hépatologie, CHU Mustapha, Algiers, Algeria
| | - Nabil Debzi
- Service d'Hépatologie, CHU Mustapha, Algiers, Algeria
| | - Paul Dény
- Service de Bactériologie, Virologie-Hygiène, Laboratoire associé au Centre National de Référence des Hépatites B, C et delta, Hôpital Avicenne, Bobigny, France
| | - Emmanuel Gordien
- Service de Bactériologie, Virologie-Hygiène, Laboratoire associé au Centre National de Référence des Hépatites B, C et delta, Hôpital Avicenne, Bobigny, France
| | - Mohamed Tazir
- Service de Microbiologie, CHU Mustapha, Algiers, Algeria
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16
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Prevalence of hepatitis D virus infection in sub-Saharan Africa: a systematic review and meta-analysis. LANCET GLOBAL HEALTH 2018; 5:e992-e1003. [PMID: 28911765 PMCID: PMC5599428 DOI: 10.1016/s2214-109x(17)30298-x] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 04/26/2017] [Accepted: 07/18/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Hepatitis D virus (also known as hepatitis delta virus) can establish a persistent infection in people with chronic hepatitis B, leading to accelerated progression of liver disease. In sub-Saharan Africa, where HBsAg prevalence is higher than 8%, hepatitis D virus might represent an important additive cause of chronic liver disease. We aimed to establish the prevalence of hepatitis D virus among HBsAg-positive populations in sub-Saharan Africa. METHODS We systematically reviewed studies of hepatitis D virus prevalence among HBsAg-positive populations in sub-Saharan Africa. We searched PubMed, Embase, and Scopus for papers published between Jan 1, 1995, and Aug 30, 2016, in which patient selection criteria and geographical setting were described. Search strings included sub-Saharan Africa, the countries therein, and permutations of hepatitis D virus. Cohort data were also added from HIV-positive populations in Malawi and Ghana. Populations undergoing assessment in liver disease clinics and those sampled from other populations (defined as general populations) were analysed. We did a meta-analysis with a DerSimonian-Laird random-effects model to calculate a pooled estimate of hepatitis D virus seroprevalence. FINDINGS Of 374 studies identified by our search, 30 were included in our study, only eight of which included detection of hepatitis D virus RNA among anti-hepatitis D virus seropositive participants. In west Africa, the pooled seroprevalence of hepatitis D virus was 7·33% (95% CI 3·55-12·20) in general populations and 9·57% (2·31-20·43) in liver-disease populations. In central Africa, seroprevalence was 25·64% (12·09-42·00) in general populations and 37·77% (12·13-67·54) in liver-disease populations. In east and southern Africa, seroprevalence was 0·05% (0·00-1·78) in general populations. The odds ratio for anti-hepatitis D virus detection among HBsAg-positive patients with liver fibrosis or hepatocellular carcinoma was 5·24 (95% CI 2·74-10·01; p<0·0001) relative to asymptomatic controls. INTERPRETATION Findings suggest localised clusters of hepatitis D virus endemicity across sub-Saharan Africa. Epidemiological data are needed from southern and east Africa, and from patients with established liver disease. Further studies should aim to define the reliability of hepatitis D virus testing methods, identify risk factors for transmission, and characterise the natural history of the infection in the region. FUNDING Wellcome Trust, Royal Society.
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17
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Heller T, Koh C, Glenn JS. Hepatitis D. ZAKIM AND BOYER'S HEPATOLOGY 2018:501-511.e4. [DOI: 10.1016/b978-0-323-37591-7.00034-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
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18
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Katwesigye E, Seremba E, Semitala F, Ocama P. Low sero-prevalence of hepatitis delta antibodies in HIV/ hepatitis B co-infected patients attending an urban HIV clinic in Uganda. Afr Health Sci 2017; 17:974-978. [PMID: 29937867 PMCID: PMC5870270 DOI: 10.4314/ahs.v17i4.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Co-infection with hepatitis B (HBV) and hepatitis D (HDV) is common among human immunodeficiency virus (HIV) infected individuals in developing countries and it aggressively accelerates progression of liver disease to cirrhosis and other complications. There is scarcity of data on HDV in sub-Saharan Africa .We investigated the sero-prevalence and factors associated with HDV antibody among HIV/HBV co-infected patients attending a large urban HIV clinic in Uganda. Methods We screened 189 HIV/HBV co-infected individuals for anti-HDV immunoglobulin G (IgG) and performed logistic regression to determine the associated factors. Socio-demographic, clinical data, immunological status, and liver fibrosis (as determined by the Aspartate transaminase to platelet ratio index and transient elastography) were included. Results Participants were predominately young and of sound immunologic status (median age 40 years, median CD4 440 cells/µl). 98% were on ART regimens containing anti-HBV active medications (95.2% were on TDF/3TC while 4.8% on 3TC containing regimen). Median duration on ART was 36 months (IQR 22–72). Anti-HDV was detected in 6/198, 3.2% (95% CI 1.14–6.92%), associated with male gender and a duration of more than 5 years since HIV diagnosis. Conclusions The sero-prevalence of HDV antibodies among the HIV/HBV co-infected patients is low in a Ugandan urban cohort.
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Affiliation(s)
- Elizabeth Katwesigye
- Department of Medicine, Mulago Hospital and Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Fred Semitala
- Department of Medicine, Mulago Hospital and Makerere University College of Health Sciences, Kampala, Uganda
| | - Ponsiano Ocama
- Department of Medicine, Mulago Hospital and Makerere University College of Health Sciences, Kampala, Uganda
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19
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Elazar M, Koh C, Glenn JS. Hepatitis delta infection - Current and new treatment options. Best Pract Res Clin Gastroenterol 2017; 31:321-327. [PMID: 28774414 DOI: 10.1016/j.bpg.2017.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 05/13/2017] [Indexed: 01/31/2023]
Abstract
In humans, hepatitis D virus (HDV) infection only occurs in the presence of a concomitant hepatitis B virus (HBV) infection, and induces the most severe form of human viral hepatitis. Even though HDV is spread worldwide and is endemic in some regions, screening and treatment has been often neglected in part due to the lack of an effective therapy. Moreover, HDV prevalence rates are increasing in many countries driven by immigration from areas of high endemicity. Currently, no FDA-approved anti-HDV therapy is available, although interferon (IFN) alpha therapy has demonstrated benefit in a minority of patients. In this review, we present a current view of our understanding of the epidemiology, molecular virology and management of HDV infection. We additionally discuss new treatment approaches in development and describe the most promising results of recent and ongoing clinical trials of these new potential agents.
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Affiliation(s)
- Menashe Elazar
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 269 Campus Drive, Stanford, CA 94305, USA.
| | - Christopher Koh
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, NIH, 10 Center Drive, CRC, 5-2740 Bethesda, MD 20892 USA.
| | - Jeffrey S Glenn
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 269 Campus Drive, Stanford, CA 94305, USA; Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA; Veterans Administration Medical Center, Palo Alto, CA, USA.
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20
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Katwesigye E, Seremba E, Semitala F, Ocama P. Low sero-prevalence of hepatitis delta antibodies in HIV/ hepatitis B co-infected patients attending an urban HIV clinic in Uganda. Afr Health Sci 2016; 16:1089-1093. [PMID: 28479902 DOI: 10.4314/ahs.v16i4.26] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Co-infection with hepatitis B (HBV) and hepatitis D (HDV) is common among human immunodeficiency virus (HIV) infected individuals in developing countries and it aggressively accelerates progression of liver disease to cirrhosis and other complications. There is scarcity of data on HDV in sub-Saharan Africa .We investigated the sero-prevalence and factors associated with HDV antibody among HIV/HBV co-infected patients attending a large urban HIV clinic in Uganda. METHODS We screened 189 HIV/HBV co-infected individuals for anti-HDV immunoglobulin G (IgG) and performed logistic regression to determine the associated factors. Socio-demographic, clinical data, immunological status, and liver fibrosis (as determined by the Aspartate transaminase to platelet ratio index and transient elastography) were included. RESULTS Participants were predominately young and of sound immunologic status (median age 40 years, median CD4 440 cells/µl). 98% were on ART regimens containing anti-HBV active medications (95.2% were on TDF/3TC while 4.8% on 3TC containing regimen). Median duration on ART was 36 months (IQR 22-72). Anti-HDV was detected in 6/198, 3.2% (95% CI 1.14-6.92%), associated with male gender and a duration of more than 5 years since HIV diagnosis. CONCLUSIONS The sero-prevalence of HDV antibodies among the HIV/HBV co-infected patients is low in a Ugandan urban cohort.
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Affiliation(s)
- Elizabeth Katwesigye
- Department of Medicine, Mulago Hospital and Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Fred Semitala
- Department of Medicine, Mulago Hospital and Makerere University College of Health Sciences, Kampala, Uganda
| | - Ponsiano Ocama
- Department of Medicine, Mulago Hospital and Makerere University College of Health Sciences, Kampala, Uganda
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21
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Hepatitis C Virus in North Africa: An Emerging Threat. ScientificWorldJournal 2016; 2016:7370524. [PMID: 27610403 PMCID: PMC5004010 DOI: 10.1155/2016/7370524] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/21/2016] [Accepted: 07/19/2016] [Indexed: 02/08/2023] Open
Abstract
Hepatitis C virus is a major public health threat associated with serious clinical consequences worldwide. North Africa is a unique region composed of seven countries that vary considerably in the predisposing factors to microbial diseases both historically and at the present time. The dynamics of HCV in the region are not well documented. The data are both limited and controversial in most of the countries in the region. In North Africa, the epidemiology of HCV is disparate and understanding it has been hampered by regional "epidemiological homogeneity" concepts. As the dynamics of HCV vary from country to country, context-specific research is needed. In this review, we assess studies performed in each country in the general populations as well as among blood donors and groups exposed to the HCV infection. The reported prevalence of HCV ranges from 0.6% to 8.4% in the Maghreb countries and is predominated by genotype 1. In the Nile valley region, it ranges from 2.2% to 18.9% and is dominated by genotype 4. In North African countries, HCV seems to be a serious problem that is driven by different vectors even in different geographical locations within the same country. Efforts should be combined at both the national and regional levels to implement efficient preventive and treatment strategies.
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Hepatocarcinogenesis associated with hepatitis B, delta and C viruses. Curr Opin Virol 2016; 20:1-10. [PMID: 27504999 DOI: 10.1016/j.coviro.2016.07.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 07/20/2016] [Accepted: 07/20/2016] [Indexed: 12/13/2022]
Abstract
Globally, over half a billion people are persistently infected with hepatitis B (HBV) and/or hepatitis C viruses. Chronic HBV and HCV infection frequently lead to fibrosis, cirrhosis and hepatocellular carcinoma (HCC). Co-infections with hepatitis delta virus (HDV), a subviral satellite requiring HBV for its propagation, accelerates the progression of liver disease toward HCC. The mechanisms by which these viruses cause malignant transformation, culminating in HCC, remain incompletely understood, partially due to the lack of adequate experimental models for dissecting these complex disease processes in vivo.
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23
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Mhalla S, Kadri Y, Alibi S, Letaief A, Boukadida J, Hannachi N. Hepatitis D Virus Infection Among Hepatitis B Surface Antigen Carriers and in "Isolated anti-HBc" Antibodies Profile in Central Tunisia. HEPATITIS MONTHLY 2016; 16:e32354. [PMID: 27110257 PMCID: PMC4834381 DOI: 10.5812/hepatmon.32354] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/31/2015] [Accepted: 12/04/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatitis D Virus (HDV) causes accelerated liver diseases in patients with Hepatitis B Virus (HBV) infection. There is lack of data about its prevalence, related risk factors and interaction with HBV carriers in our country. OBJECTIVES The aim of this study was to estimate the prevalence of hepatitis delta and associated risk factors among Hepatitis B surface antigen (HBsAg) and "isolated anti-HBc" profile carriers in central Tunisia. PATIENTS AND METHODS In this cross-sectional study, 540 patients with positive HBsAg and 109 "isolated anti-HBc" profile receiving care in a teaching hospital were tested for the presence of HDV serum-markers using commercially available enzyme immunoassay kit. HBV-DNA was detected by nested PCR in "isolated anti-HBc" profile group. RESULTS Prevalence of HDV was 8.1% in HBsAg carriers group, but it was significantly higher in active than inactive hepatitis (30.2% and 4.5%, respectively, OR = 9, 95% CI: [4.48-18.58]). There was no significant association between studied risk factors and HDV infection. In the "isolated anti-HBc" profile group, prevalence of HDV was 4.6% and HBV-DNA had negative result in all patients with positive results for HDV. CONCLUSIONS Although HDV had low prevalence in our area, it is vital to plan preventive strategies for HDV spread as well as HBV prevention. It is particularly important to suspect HDV infection in active HBV carriers to manage a particularly severe dual infection. HDV infection should be suspected even in negative HBsAg patients having "isolated anti-HBc" profile.
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Affiliation(s)
- Salma Mhalla
- Laboratory of Microbiology and Immunology, F. Hached Teaching Hospital, (UR12SP34) University of Sousse, Sousse, Tunisia
- Department of Microbiology, Fattouma Bourguiba Teaching Hospital, University of Monastir, Monastir, Tunisia
- Corresponding Author: Salma Mhalla, Department of Microbiology, Fattouma Bourguiba Teaching Hospital, University of Monastir, Monastir, Tunisia. E-mail:
| | - Yosr Kadri
- Department of Microbiology, Fattouma Bourguiba Teaching Hospital, University of Monastir, Monastir, Tunisia
| | - Sana Alibi
- Laboratory of Microbiology and Immunology, F. Hached Teaching Hospital, (UR12SP34) University of Sousse, Sousse, Tunisia
| | - Amel Letaief
- Department of Infectious Disease, F. Hached Teaching Hospital, University of Sousse, Sousse, Tunisia
| | - Jalel Boukadida
- Laboratory of Microbiology and Immunology, F. Hached Teaching Hospital, (UR12SP34) University of Sousse, Sousse, Tunisia
| | - Naila Hannachi
- Laboratory of Microbiology and Immunology, F. Hached Teaching Hospital, (UR12SP34) University of Sousse, Sousse, Tunisia
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24
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Séroprévalence de l’infection par le virus de l’hépatite D dans une population de donneurs de sang porteurs de l’Antigène HBs au Centre régional de transfusion sanguine de Bobo-Dioulasso. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s12157-015-0646-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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25
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Alfaiate D, Dény P, Durantel D. Hepatitis delta virus: From biological and medical aspects to current and investigational therapeutic options. Antiviral Res 2015; 122:112-29. [PMID: 26275800 DOI: 10.1016/j.antiviral.2015.08.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 12/14/2022]
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26
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Deranged liver function tests in a patient with hepatitis B. J Clin Virol 2015; 66:90-4. [PMID: 25866345 DOI: 10.1016/j.jcv.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/24/2015] [Accepted: 03/04/2015] [Indexed: 11/23/2022]
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27
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Analysis of hepatitis B virus drug-resistant mutation (M204V) using molecular dynamics simulation techniques. Biologia (Bratisl) 2014. [DOI: 10.2478/s11756-014-0471-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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28
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Hønge BL, Jespersen S, Medina C, Té DDS, da Silva ZJ, Lewin S, Østergaard L, Erikstrup C, Wejse C, Laursen AL, Krarup H, for the Bissau HIV cohort study group. Hepatitis B and Delta virus are prevalent but often subclinical co-infections among HIV infected patients in Guinea-Bissau, West Africa: a cross-sectional study. PLoS One 2014; 9:e99971. [PMID: 24915064 PMCID: PMC4051771 DOI: 10.1371/journal.pone.0099971] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 05/21/2014] [Indexed: 02/07/2023] Open
Abstract
Background Co-infection with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) may lead to accelerated hepatic disease progression with higher rates of liver cirrhosis and liver-related mortality compared with HBV mono-infection. Co or super-infection with hepatitis Delta virus (HDV) may worsen the liver disease and complicate treatment possibilities. Methods In this cross-sectional study we included HIV-infected individuals who had a routine blood analysis performed at an HIV clinic in Bissau, Guinea-Bissau between the 28th of April and 30th of September 2011. All patients were interviewed, had a clinical exam performed and had a blood sample stored. The patients' samples were tested for HBV and HDV serology, and HBV/HDV viral loads were analyzed using in-house real-time PCR methods. Results In total, 576 patients (417 HIV-1, 104 HIV-2 and 55 HIV-1/2) were included in this study. Ninety-four (16.3%) patients were HBsAg positive of whom 16 (17.0%) were HBeAg positive. In multivariable logistic regression analysis, CD4 cell count <200 cells/ µl and animist religion were significantly associated with HBsAg positivity. Due to scarcity of available plasma, virological analyses were not performed for eight patients. HBV DNA was detected in 42 of 86 samples (48.8%) positive for HBsAg and genotyping was performed in 26 patients; 25 of whom had genotype E and one genotype D. Among 9 patients on antiretroviral treatment (ART), one patient had the [L180M, M204V] mutation associated with lamivudine resistance. Among the HBsAg positive patients 25.0% were also positive for anti-HDV and 4/9 (44.4%) had detectable HDV RNA. Conclusion HBV and HDV were frequent co-infections among HIV positive patients in Guinea-Bissau and chronic infection was associated with severe immunosuppression. Lamivudine was widely used among HBsAg positive patients with the risk of developing resistant HBV.
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Affiliation(s)
- Bo Langhoff Hønge
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
| | - Sanne Jespersen
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Candida Medina
- National HIV Programme, Ministry of Health, Bissau, Guinea-Bissau
| | | | - Zacarias José da Silva
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- National Public Health Laboratory, Bissau, Guinea-Bissau
| | - Sharon Lewin
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia
| | - Lars Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Wejse
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- GloHAU, Center for Global Health, School of Public Health, Aarhus University, Aarhus, Denmark
| | - Alex Lund Laursen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Krarup
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
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29
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Han M, Littlejohn M, Yuen L, Edwards R, Devi U, Bowden S, Ning Q, Locarnini S, Jackson K. Molecular epidemiology of hepatitis delta virus in the Western Pacific region. J Clin Virol 2014; 61:34-9. [PMID: 24973283 DOI: 10.1016/j.jcv.2014.05.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/22/2014] [Accepted: 05/30/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hepatitis delta virus (HDV) is a defective RNA virus requiring the presence of the hepatitis B virus (HBV) for the completion of its life cycle. Active replication of HDV can lead to severe hepatitis, and although present worldwide has an irregular geographical distribution, especially in the Asian Pacific region. OBJECTIVES The aim of this study was to determine the prevalence and molecular epidemiology of HDV isolates in Oceania following the 1998 evaluation of the hepatitis B vaccine program. STUDY DESIGN Sera collected from 184 hepatitis B surface antigen (HBsAg) positive Pacific Islanders living in Micronesia, Polynesia and Melanesia were tested for HDV RNA. RESULTS Twenty of 54 patients with chronic hepatitis B (CHB) from Kiribati were positive for serum HDV RNA (37%), whilst sera from patients with CHB from Tonga (59), Fiji (42) and Vanuatu (29) were negative. The mean HDV RNA load for the 20 samples was 7.00log10copies/mL. Phylogenetic analysis revealed that the Kiribati HDV isolates were of genotype 1 and clustered with a previously published isolate from Nauru forming a distinct clade of Pacific HDV. All Micronesian isolates contained a serine at codon 202 of large hepatitis delta antigen (L-HDAg) demonstrating possible relatedness to strains of HDV-1 of African origin. CONCLUSIONS This study has confirmed endemic HDV infection in Micronesia and identified Kiribati as having amongst the highest prevalence for HDV viraemia in patients with CHB. Further investigations are ongoing into the origins of this unique HDV Pacific strain, and its inter-relationship with HBV.
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Affiliation(s)
- Meifang Han
- Research & Molecular Development, VIDRL, 10 Wreckyn Street, North Melbourne 3051, Australia; Department of Infectious Diseases, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.
| | - Margaret Littlejohn
- Research & Molecular Development, VIDRL, 10 Wreckyn Street, North Melbourne 3051, Australia.
| | - Lilly Yuen
- Research & Molecular Development, VIDRL, 10 Wreckyn Street, North Melbourne 3051, Australia.
| | - Rosalind Edwards
- Research & Molecular Development, VIDRL, 10 Wreckyn Street, North Melbourne 3051, Australia.
| | - Uma Devi
- Research & Molecular Development, VIDRL, 10 Wreckyn Street, North Melbourne 3051, Australia.
| | - Scott Bowden
- Research & Molecular Development, VIDRL, 10 Wreckyn Street, North Melbourne 3051, Australia.
| | - Qin Ning
- Department of Infectious Diseases, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.
| | - Stephen Locarnini
- Research & Molecular Development, VIDRL, 10 Wreckyn Street, North Melbourne 3051, Australia.
| | - Kathy Jackson
- Research & Molecular Development, VIDRL, 10 Wreckyn Street, North Melbourne 3051, Australia.
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30
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Abstract
Hepatitis D virus (HDV) is a satellite of hepatitis B virus (HBV), and infection with this virus aggravates acute and chronic liver disease. While HBV seroprevalence is very high across sub-Saharan Africa, much less is known about HDV in the region. In this study, almost 2,300 blood serum samples from Burkina Faso (n=1,131), Nigeria (n=974), Chad (n=50), and the Central African Republic (n = 118) were screened for HBV and HDV. Among 743 HBsAg-positive serum samples, 74 were positive for HDV antibodies and/or HDV RNA, with considerable differences in prevalence, ranging from <2% (pregnant women from Burkina Faso) to 50% (liver patients from Central African Republic). HDV seems to be much more common in chronic liver disease patients in the Central African Republic (CAR) than in similar cohorts in Nigeria. In a large nested mother-child cohort in Burkina Faso, the prevalence of HDV antibodies was 10 times higher in the children than in their mothers, despite similar HBsAg prevalences, excluding vertical transmission as an important route of infection. The genotyping of 16 full-length and 8 partial HDV strains revealed clade 1 (17/24) in three of the four countries, while clades 5 (5/24) and 6 (2/24) were, at least in this study, confined to Central Nigeria. On the amino acid level, almost all our clade 1 strains exhibited a serine at position 202 in the hepatitis D antigen, supporting the hypothesis of an ancient African HDV-1 subgroup. Further studies are required to understand the public health significance of the highly varied HDV prevalences in different cohorts and countries in sub-Saharan Africa.
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31
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Serological and molecular diagnosis of hepatitis delta virus infection: results of a French national quality control study. J Clin Microbiol 2014; 52:1694-7. [PMID: 24523467 DOI: 10.1128/jcm.03521-13] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A French national quality control study for the serological and molecular diagnosis of hepatitis delta virus (HDV) was organized. Total HDV antibodies were properly detected by all laboratories; 8/14 laboratories failed to detect low titers of IgM, and 6/11 failed to quantify and/or underestimated the RNA viral load in several samples. These discrepancies are likely related to the molecular diversity of HDV.
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Noureddin M, Gish R. Hepatitis delta: epidemiology, diagnosis and management 36 years after discovery. Curr Gastroenterol Rep 2014; 16:365. [PMID: 24293018 PMCID: PMC3918112 DOI: 10.1007/s11894-013-0365-x] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
With recent studies showing increased prevalence of hepatitis delta (HDV) even in the US, Australia, and some countries in Europe, and very high prevalence in endemic regions, HDV infection is far from being a disappearing disease. Although immigrants from endemic countries have been shown to have increased risk, studies have clearly shown that the disease is not solely appearing in traditional high-risk groups. Recent studies provide increasing evidence that sexual transmission may be an important factor in HDV infection spread. Based on the totality of evidence showing increased disease progression and substantially increased risk of cirrhosis in HDV-infected CHB patients, and the current studies showing higher than expected prevalence, it is time to call for HDV screening of all CHB patients. HDV viral load detection and measurement should be considered in all patients whether or not they are anti-HDV-positive. With universal screening of CHB patients for HDV, earlier diagnosis and consideration of treatment would be possible. Current treatment of HDV is IFN-based therapy with or without HBV antivirals, but current research indicates the possibility that prenylation inhibitors, entry inhibitors, HBsAg release inhibitors, or other therapies currently in the pipeline may provide more effective therapy in the future. In addition, universal screening would serve the important public health goal of allowing patients to be educated on their status and on the need for HDV-negative patients to protect themselves against superinfection and for HDV-infected patients to protect against transmission to others. Further studies and global awareness of HDV infection are needed.
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Affiliation(s)
- Mazen Noureddin
- Division of Gastroenterology and Hepatology, Keck School of Medicine, University of Southern California, 2011 Zonal Avenue, HMR 101, Los Angeles, CA 90033 USA
| | - Robert Gish
- Robert G. Gish Consultants, LLC, San Diego, CA USA
- St. Joseph’s Hospital and Medical Center, Phoenix, AZ USA
- University of Nevada, Las Vegas, 6022 La Jolla Mesa Drive, San Diego, CA 92037 USA
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