Abstract
The sero-prevalence of co-infection with the hepatitis B virus (HBV) and the hepatitis D virus (HDV) is well known in many European countries, starting from 6.8% in Germany to more than 27% in some Turkish areas. To gain a better description of this infection in Switzerland, and to characterise those affected, a questionnaire was sent to all Swiss gastroenterologists, hepatologists and infectologists. A questionnaire was received by 349 physicians which asked them to report on all HBV- and HDV-infected patients seen at their units/offices. A total of 101 HDV-positive patients seen by 78 specialists were analysed. The physicians were in charge of 1'699 patients with chronic hepatitis B, giving a 5.9% prevalence of HDV infection in HBV-positive patients. A predominance of males (75%) from Switzerland (39%), and of African origin (21%) was recorded. Most had been contaminated by intravenous drug use (62%), followed by vertical transmission (15%), sexual contact (13%) or transfusion with blood or blood products (2%). The majority (74%) had a very low (<103 UI/ml) HBV viral load and 75% were HBeAg-negative. A total of 76% percent of those who had a liver biopsy had significant fibrosis (≥F2), and only 21% had received standard therapy (interferon or pegylated interferon-α). Overall, 10% recovered spontaneously (anti-HBs-positive). With a prevalence of 5.9% of hepatitis D in HBsAg-positive patients, Switzerland seems less affected than most other European countries, however, it is possible that this infection is under-diagnosed. Intravenous drug use was the main risk factor. Associated advanced liver disease was also very common.
Highlights
Hepatitis D virus (HDV) is a defective RNA virus that requires the helper function of hepatitis B virus (HBV) for its assembly and transmission [1]
A questionnaire was received by 349 physicians which asked them to report on all HBV- and hepatitis D virus (HDV)-infected patients seen at their units/offices
With a prevalence of 5.9% of hepatitis D in hepatitis B surface antigen (HBsAg)-positive patients, Switzerland seems less affected than most other European countries, it is possible that this infection is under-diagnosed
Summary
Hepatitis D virus (HDV) is a defective RNA virus that requires the helper function of hepatitis B virus (HBV) for its assembly and transmission [1]. HDV is the smallest animal virus and the only one to possess a circular RNA genome and a single structural protein, the hepatitis delta antigen (HDAg), surrounded by an envelope containing the hepatitis B surface antigen (HBsAg) [2] Since it uses the surface antigen of the HBV to enter hepatocytes as well as for cellto-cell spread, HDV can only infect those who are already chronic HBV carriers (super-infection) or co-infect people simultaneously with HBV (co-infection) [3]. More than 350 million people are considered to have chronic HBV infection, and 15–20 million of them are thought to be infected with HDV [5] Few countries know their HDV prevalence, since studies concerning this disease are scarce. Since epidemiological data for Switzerland is missing, the aim of the current study was to evaluate the prevalence of HDV infection and describe the profile of patients infected by HDV in this country
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