Abstract
Hepatitis D caused by the hepatitis delta virus (HDV) is a serious health problem in many regions of the world. A total of 546 HBV-infected patients were enrolled from 2013 to 2015 and classified clinically into the subgroups of chronic hepatitis B (CHB, n = 191), liver cirrhosis (LC, n = 147) and hepatocellular carcinoma (HCC, n = 208). The patients were screened for HDV-RNA by nested PCR assays. HDV genotypes were assessed by direct sequencing, followed by phylogenetic analysis. HDV-RNA was identified in 13% (71/546) of HBV-infected patients. The highest HDV prevalence was found in the LC group (19.7%), followed by the HCC (12%) and CHB (8.9%) groups (P = 0.017). HDV/HBV coinfections were significantly associated with a rather unfavourable clinical outcome, in particular with LC development compared to HBV monoinfection. Phylogenetic analyses indicated that the genotype HDV1 was, with a prevalence of 91%, by far the most common genotype in Vietnam, followed by HDV2 with 9%. Other HDV genotypes were not observed. In accordance with previous data obtained a decade ago, our results confirm a continuing high prevalence of HDV infection in hepatitis B patients in northern Vietnam with the HDV1 genotype still being the predominant genotype. HDV nucleic acid testing to minimize the associated risk should be considered.
Highlights
Hepatitis delta virus (HDV), firstly identified in 19771, is a defective virus which uses hepatitis B virus (HBV) envelope proteins for successful infection of hepatocytes2
Albumin and prothrombin levels as well as platelet counts were significantly lower in the liver cirrhosis (LC) group compared to the other groups (P < 0.001) and direct and indirect bilirubin levels were higher in the LC compared to the CHB and hepatocellular carcinoma (HCC) groups (P < 0.0001)
We evaluated the impact of the HDV1 and HDV2 genotypes on the clinical outcome in HBV-infected patients by comparing the levels of biomedical parameters, including HBV-DNA loads, liver enzymes, bilirubin, albumin, prothrombin, and platelet counts
Summary
Hepatitis delta virus (HDV), firstly identified in 19771, is a defective virus which uses hepatitis B virus (HBV) envelope proteins for successful infection of hepatocytes. The HDV virion is composed of an outer coat containing HBV envelope proteins and host lipids surrounding an inner nucleocapsid that consists of small and large hepatitis delta antigens (HDAg) and a single-stranded circular RNA of 1679 nucleotides. The HDV virion is composed of an outer coat containing HBV envelope proteins and host lipids surrounding an inner nucleocapsid that consists of small and large hepatitis delta antigens (HDAg) and a single-stranded circular RNA of 1679 nucleotides3 Both HBV and HDV use the Na+-taurocholate cotransporting polypeptide (NTCP) bile transporter to gain entry to the hepatocytes. The HDV1 genotype occurs worldwide and is associated with both severe and mild clinical forms of viral hepatitis. The HDV prevalence in sub-Saharan African countries was estimated to be 1.3% to 50%18
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