Detection and Genetic Characterization of Hepatitis B and D Viruses: A Multi-Site Cross-Sectional Study of People Who Use Illicit Drugs in the Amazon Region.

Ronylson José S Silva,Camila Moraes Gomes,Aldemir B Oliveira-Filho,José Augusto J Oliveira-Neto,Emil Kupek,José Alexandre R Lemos,João Renato R Pinho,Benedikt Fischer,Luiz Fernando A Machado,Juliana Nádia F Piauiense,Luísa Caricio Martins,Rafael Lima Resque,Fabricio Quaresma Silva,Raquel Silva Do Nascimento,Luiz Marcelo L Pinheiro

doi:10.3390/v13071380

Abstract

Hepatitis B (HBV) and delta (HDV) viruses are endemic in the Amazon region, but vaccine coverage against HBV is still limited. People who use illicit drugs (PWUDs) represent a high-risk group due to common risk behavior and socioeconomic factors that facilitate the acquisition and transmission of pathogens. The present study assessed the presence of HBV and HBV-HDV co-infection, identified viral sub-genotypes, and verified the occurrence of mutations in coding regions for HBsAg and part of the polymerase in HBV-infected PWUDs in municipalities of the Brazilian states of Amapá and Pará, in the Amazon region. In total, 1074 PWUDs provided blood samples and personal data in 30 municipalities of the Brazilian Amazon. HBV and HDV were detected by enzyme-linked immunosorbent assay and polymerase chain reaction. Viral genotypes were identified by nucleotide sequencing followed by phylogenetic analysis, whereas viral mutations were analyzed by specialized software. High rates of serological (32.2%) and molecular (7.2%) markers for HBV were detected, including cases of occult HBV infection (2.5%). Sub-genotypes A1, A2, D4, and F2a were most frequently found. Escape mutations due to vaccine and antiviral resistance were identified. Among PWUDs with HBV DNA, serological (19.5%) and molecular (11.7%) HDV markers were detected, such as HDV genotypes 1 and 3. These are worrying findings, presenting clear implications for urgent prevention and treatment needs for the carriers of these viruses.

Highlights

Hepatitis B virus (HBV) infection is a global public health problem with approximately two billion people worldwide infected in the past and 257 million chronic carriers [1]
The present study identified relevant information on the epidemiology of HBV infection and HBV-hepatitis delta virus (HDV) co-infection among People who use illicit drugs (PWUDs) in the Brazilian states of Amapá and Pará, in the Amazon region
This can be used to direct actions for diagnosis and treatment of current viral infections and to prevent new infections, as well as serving as a strong incentive to promote the health of PWUDs in this Brazilian region and other parts of the world with similar characteristics

Summary

Introduction

Hepatitis B virus (HBV) infection is a global public health problem with approximately two billion people worldwide infected in the past and 257 million chronic carriers [1]. HBV belongs to the Hepadnaviridae family and possesses a partial double-strand DNA genome of approximately 3.2kb. Ten HBV genotypes (A–J) have already been described, with nucleotide sequence divergences greater than 8% in the entire viral genome [5]. Most genotypes have several subgenotypes that may lead to different outcomes in chronicity after infection, disease progression, and responses to IFNα treatment [5,6]. HBV mutations in the regions of the polymerase (P), core (C), surface antigen (S), and X proteins are considered important because they can influence the outcome of the HBV infection, increasing the risk of developing liver cirrhosis and hepatocellular carcinoma in response to treatment with antiviral drugs and in the immunological escape of the vaccine [9,10,11,12]

Methods

Results

Conclusion