Prevalence Of Hepatitis Delta Virus Research Articles

Hepatitis Delta Virus Testing and Prevalence Among Chronic Hepatitis B Patients Across Three U.S. Safety-Net Health Systems

Background & AimsDespite a high prevalence of risk factors associated with hepatitis delta virus (HDV) infection among safety-net populations, data evaluating HDV testing and prevalence are limited. We aim to evaluate HDV testing practices and HDV prevalence among an ethnically diverse, multi-center cohort of safety-net patients with chronic hepatitis B (CHB). MethodsWe retrospectively evaluated 13,218 patients with CHB (54.2% male, 57.9% non-white minorities, 12.5% HIV, 23.0% HCV) across three U.S. safety-net health systems from 2010-2022 to evaluate proportion tested for HDV and proportion positive among those tested. Adjusted multivariate logistic regression models evaluated for predictors of HDV testing and predictors of anti-HDV positive. ResultsAnti-HDV testing was performed in 6.1% overall and in 4.9% that met AASLD criteria for HDV testing. Greater odds of testing was observed in men vs. women (OR 1.49, 95%CI 1.27–1.75), Asian individuals vs. white individuals (OR 2.18, 95%CI 1.74-2.72), black/African American individuals vs. white individuals (OR 1.29, 95%CI 1.07-1.56), and patients with Medicare or Medicaid. Among CHB patients tested for HDV, 15.7% were positive (22.9% among those meeting AASLD HDV testing criteria). Only 2 (1.6%) patients had follow-up HDV RNA testing. Greater proportion of anti-HDV positive was observed in patients with baseline cirrhosis (47.4% vs. 13.3%, p<0.001), and patients with Medicare or Medicaid vs. those with commercial insurance. ConclusionsAmong an ethnically diverse, multi-center safety-net cohort of CHB patients, low rates of HDV testing were observed, even among those with high-risk HDV risk factors. Among those tested, 15.7% were positive, only 2 had follow up RNA testing. This highlights the need for greater awareness, education, and advocacy to improve HDV testing rates.

Hepatitis Delta Virus Clade 8 Is the Predominant Clade Circulating in Botswana amongst People Living with HIV.

Hepatitis delta virus (HDV) co-infections more often result in severe hepatitis compared to hepatitis B virus (HBV) infections alone. Despite a high HDV prevalence (7.1%), information regarding circulating HDV clades is very limited in Botswana. We extracted total nucleic acid from confirmed HDV-positive samples and quantified their viral load. We then sequenced the large hepatitis delta antigen (L-HDAg) using Oxford Nanopore Technology (ONT). Genotyping was performed using the HDV Database, and HDV mutation profiling was performed on AliView. All participants with HBV genotypic information belonged to sub-genotype A1, and 80% (4/5) of them had a higher HDV viral load and a lower HBV viral load. We sequenced 75% (9/12) of the HDV-positive samples, which belonged to HDV clade 8. A total of 54 mutations were discovered, with the most prevalent being Q148R (16%), D149P (16%) and G151D (16%). Known mutations such as S117A, K131R, R139K and G151D were detected, while the other mutations were novel. Our results reveal that HDV clade 8 is the predominant clade in Botswana. The significance of all mutations remains unclear. Future studies with a larger sample size to detect other HDV clades that might be circulating in Botswana and functionally characterize the detected mutations are warranted.

The Prevalence and Molecular Epidemiology of Hepatitis Delta Virus in Nigeria: The Results of a Nationwide Study.

Hepatitis delta virus (HDV) is a satellite of hepatitis B virus (HBV), which requires the HBV surface antigen (HBsAg) for its assembly and propagation. Although countries affected by HBV infection in Africa are well identified, data on HDV infection are still scarce, like in Nigeria, where HBV infection is endemic. In this study, we aimed to determine the prevalence of HDV infection and identify the circulating genotypes/strains in the country. A nationwide study was performed on 1281 HBsAg-positive samples collected from patients across eleven sites drawn from the six geopolitical zones in Nigeria. Anti-HDV antibody (HDV-Ab) screening and HDV-RNA viral load quantification were performed using a commercial ELISA assay and real-time RT-PCR kit, respectively. HDV genotyping was performed by the Sanger sequencing of amplicons from the so-called R0 region of the viral genome, followed by phylogenetic analyses. Of the 1281 HBsAg-positive samples, 61 (4.8%) were HDV-Ab positive, among which, 12 (19.7%) were HDV-RNA positive. Genotypes were obtained for nine of them: seven "African" HDV-1, one "Asian/European" HDV-1 and one HDV-6. This study shows that Nigeria is a country of low HDV prevalence where mainly "African" genotype-1 strains are circulating.

WED-431 Testing practice and prevalence of hepatitis delta virus (HDV) among patients with chronic hepatitis B (CHB): a large canadian population-based study

WED-431 Testing practice and prevalence of hepatitis delta virus (HDV) among patients with chronic hepatitis B (CHB): a large canadian population-based study

An updated assessment of hepatitis delta prevalence among adults in Canada: A meta-analysis.

Foreign-born (FB) persons represent a large proportion of adults with chronic hepatitis B (CHB) in Canada due to higher prevalence rates in countries of birth for FB persons. Suboptimal awareness and low rates of hepatitis delta virus (HDV) testing contribute to underdiagnosis and gaps in accurate estimates of Canada HDV prevalence. We aim to provide an assessment of CHB and HDV prevalence in Canada using a comprehensive literature review and meta-analysis. A comprehensive literature review of articles reporting HBsAg seroprevalence and anti-HDV prevalence was conducted to calculate country-specific rates and pooled prevalence of CHB and HDV using meta-analyses. Country-specific CHB and HDV rate estimates were combined with number of FB persons in Canada in 2021 from Statistics Canada to estimate total numbers of FB with CHB and HDV, respectively. These estimates were combined with estimates of Canada-born persons with CHB and HDV to yield the total number of persons with CHB and HDV. In 2021, we estimated 0.550 million (M) (95% CI 0.488-0.615) persons with CHB; 0.344 M (95% CI 0.288-0.401) were FB and 0.206 M (95% CI: 0.200-0.214) were Canada-born. The weighted average HDV prevalence among FB persons in Canada was 5.19% (17,848 [95% CI 9611-26,052] persons), among whom 50% emigrated from Asia and 31% from Africa. When combined with estimates of Canada-born persons with HDV, we estimate 35,059 (95% CI: 18,744-52,083) persons with HDV in Canada. In conclusion, we estimate 0.550 M and 35,059 persons living with CHB and HDV, respectively, in Canada in 2021.

A regular screening for hepatitis delta virus among chronic hepatitis B carriers improves the diagnostic of this infection and of subsequent cirrhosis development.

The prevalence of Hepatitis Delta Virus (HDV) is underestimated and the assessment of fibrosis is recommended for this infection. We tested the diagnostic impact of an annual screening for HDV serology in Hepatitis B Surface Antigen (HBs Ag) chronic carriers and followed the progression of fibrosis in these patients. Between January 2014 and October 2021, we annually tested all chronic HBs Ag-positive patients for HDV antibody (HDV Ab). Each HDV Ab positive patient underwent annually repeated elastometry. Patients with detectable HDV RNA levels (group 1) were compared to those with undetectable HDV RNA (group 2). We identified 610 chronic HBs Ag-positive patients, and repeated screening for HDV Ab was performed in 534 patients. Sixty (11%) patients were HDV Ab positive at baseline and were considered as "coinfected". Seven cases of HDV superinfection were diagnosed through repeated screening. In co-infected patients, cirrhosis was initially diagnosed in 12/60 patients and developed in six patients during follow-up. HDV RNA PCR was performed in 57/67 patients and 27 had detectable levels (group 1). Cumulative incidence of cirrhosis at 7years was 13.8% (95% CI 0-30) in group 1 and 0 (95% CI 0-0) in group 2 (p=0.026). A systematic screening for HDV in chronic HB Ag carriers revealed a high prevalence of HDV Ab. Repeated serological screening enables the diagnosis of superinfections in asymptomatic patients. Regular assessment of fibrosis using elastometry leads to the identification of incidental cirrhosis in patients with detectable HDV RNA.

The prevalence of HDV among HBsAg-positive populations with and without HIV-1 in China

BackgroundExisting research has provided evidence of changes in hepatitis delta virus (HDV) prevalence worldwide. This study aimed to investigate the prevalence and molecular characteristics of HDV to elucidate its spread in China. MethodsA total of 3,000 samples were collected from 2,241 HBV monoinfections and 759 HBV/HIV-1 coinfections across 13 sites in northern, southern, western, and southwestern China. Serological and virological prevalence were determined by detecting anti-HDV antibodies and HDV RNA. ResultsThe study revealed a 2.63% (95% CI: 2.06–3.21) seroprevalence of HDV among HBV infections in China, exhibiting regional variation. HDV seroprevalence was notably higher at 7.91% (95% CI: 5.98–9.83) in HBV and HIV-1 coinfections. Region and HIV-1 infection were identified as risk factors for HDV infection. Virological prevalence was 0.67% (95% CI: 0.38–0.96) in HBV infections and 2.24% (95% CI: 1.18–3.29) in HBV/HIV-1 coinfections. The predominant HDV genotype in China was HDV-2a, followed by HDV-1. Participants with anti-HDV positivity demonstrated significantly higher proportions of abnormal liver dysfunction and elevated HBV DNA load (P < 0.001) compared to anti-HDV-negative participants. ConclusionsThis study highlights the HDV epidemic in China, sheds light on its geographical distribution and high-risk populations, and provides insights for developing strategies to manage the spread of HDV in the country.

Adjusted estimate of the prevalence of hepatitis delta virus in 25 countries and territories

Hepatitis delta virus (HDV) is a satellite RNA virus that requires the hepatitis B virus (HBV) for assembly and propagation. Individuals infected with HDV progress to advanced liver disease faster than HBV-monoinfected individuals. Recent studies have estimated the global prevalence of anti-HDV antibodies among the HBV-infected population to be 5-15%. This study aimed to better understand HDV prevalence at the population level in 25 countries/territories. We conducted a literature review to determine the prevalence of anti-HDV and HDV RNA in hepatitis B surface antigen (HBsAg)-positive individuals in 25 countries/territories. Virtual meetings were held with experts from each setting to discuss the findings and collect unpublished data. Data were weighted for patient segments and regional heterogeneity to estimate the prevalence in the HBV-infected population. The findings were then combined with The Polaris Observatory HBV data to estimate the anti-HDV and HDV RNA prevalence in each country/territory at the population level. After adjusting for geographical distribution, disease stage and special populations, the anti-HDV prevalence among the HBsAg+ population changed from the literature estimate in 19 countries. The highest anti-HDV prevalence was 60.1% in Mongolia. Once adjusted for the size of the HBsAg+ population and HDV RNA positivity rate, China had the highest absolute number of HDV RNA+ cases. We found substantially lower HDV prevalence than previously reported, as prior meta-analyses primarily focused on studies conducted in groups/regions that have a higher probability of HBV infection: tertiary care centers, specific risk groups or geographical regions. There is large uncertainty in HDV prevalence estimates. The implementation of reflex testing would improve estimates, while also allowing earlier linkage to care for HDV RNA+ individuals. The logistical and economic burden of reflex testing on the health system would be limited, as only HBsAg+ cases would be screened. There is a great deal of uncertainty surrounding the prevalence of hepatitis delta virus among people living with hepatitis B virus at the population level. In this study, we aimed to better understand the burden in 25 countries and territories, to refine techniques that can be used in future analyses. We found a lower prevalence in the majority of places studied than had been previously reported. These data can help inform policy makers on the need to screen people living with hepatitis B virus to find those coinfected with hepatitis delta virus and at high risk of progression, while also highlighting the pitfalls that other researchers have often fallen into.

Prevalence and characteristics of hepatitis delta virus infection in patients with hepatitis B in the United States: An analysis of the All-Payer Claims Database.

HDV leads to the most severe form of viral hepatitis; however, the prevalence of HDV is not well understood. Using real-world data from the All-Payer Claims Database, this study estimates the prevalence of HBV/HDV infection among the chronic HBV population and describes patient/clinical characteristics for adults with HBV/HDV infection in the United States. Adults (≥18 years) with ≥1 inpatient claim or ≥2 outpatient claims for HDV infection or HBV in the All-Payer Claims Database from January 1, 2014, to December 31, 2020, were identified. HDV prevalence was calculated as the proportion of patients with HBV/HDV infection among total patients with HBV infection. Patient characteristics, socioeconomic status, advanced liver complications (eg, cirrhosis, HCC), and comorbidities were assessed. A total of 6719 patients were diagnosed with HBV/HDV among 144,975 with HBV and 12 months of continuous data, for a prevalence of 4.6%. At diagnosis, 31.7% of patients with HBV/HDV had advanced liver complications, including compensated cirrhosis (16.3%) and decompensated cirrhosis (10.4%). Diabetes (50.5%), hypertension (49.8%), and HIV infection (30.9%) were the top 3 comorbidities. In a large database capturing approximately 80% of the US-insured population, HBV/HDV infection prevalence was 4.6% among adults infected with HBV. Patients infected with HDV had high rates of baseline liver complications and other comorbidities at the time of diagnosis, suggesting potentially delayed diagnosis and/or treatment. Earlier identification of HBV/HDV infection among the population with HBV may provide opportunities to improve linkage to care and treatment, thereby reducing the risk of liver-related morbidity and mortality.

High prevalence of hepatitis delta virus among people with hepatitis B virus and HIV coinfection in Botswana

BackgroundApproximately 15–20 million people worldwide are infected with hepatitis delta virus (HDV), which is approximately 5 % of people with chronic hepatitis B virus (HBV). Sub-Saharan Africa has high HDV prevalence, leading to worse clinical outcomes among people who are HIV/HBV/HDV tri-infected. There are limited data on HDV prevalence among people with HIV (PWH) who are HBV-infected and uninfected in Botswana. We, therefore, determined HDV prevalence among PWH in Botswana. MethodsThis was a retrospective cross-sectional study utilizing archived plasma samples from PWH with results for HBV markers such as hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), immunoglobulin M antibody to hepatitis B core antigen (IgM anti-HBc) and hepatitis B e antigen (HBeAg). Samples were categorized according to their HBsAg status and screened for anti-HDV antibodies. Total nucleic acid was extracted from samples with a single positive anti-HDV result, and HDV ribonucleic acid (RNA) load was quantified using the Altona Diagnostic RealStar® HDV RT-PCR kit. Statistical analysis was performed using STATA version 14.0 where p-values < 0.05 were considered statistically significant. ResultsThe study cohort (n = 478) included both HBsAg positive (44 %) and negative (56 %) participants, with a median age of 42 [IQR; 41–43]. Anti-HDV prevalence of (15/211) [7.1 %, 95 % CI: 4.4 – 11.4] was recorded among HBsAg positive participants, all of whom were IgM anti-HBc negative, while 5/6 participants were HBeAg negative. HDV RNA load was detected in 11/12 (92 %) anti-HDV-positive participants. No HDV prevalence was recorded among participants who were HBsAg negative, therefore, the overall HDV prevalence was (15/478) [3.1 %, 95 % CI: 1.9 – 5.1]. HIV viral load suppression was statistically insignificant, irrespective of HDV status. ConclusionsWe report high HDV prevalence among HBsAg-positive PWH in Botswana. Most HDV-positive participants had active HDV infection, therefore, we recommend HDV screening in this cohort to guide their clinical care.

Recent prevalence and characteristics of patients with hepatitis delta virus in Hokkaido, Japan.

Although hepatitis delta virus (HDV) coinfection with hepatitis B virus (HBV) is a global health concern, the global prevalence of HDV infections remains unknown due to insufficient data in many countries. In Japan, HDV prevalence has not been updated for over 20years. We aimed to investigate the recent prevalence of HDV infections in Japan. We screened 1264 consecutive patients with HBV infection at Hokkaido University Hospital between 2006 and 2022. Patients' serums were preserved and subsequently tested for HDV antibody (immunoglobulin-G). Available clinical information was collected and analyzed. We compared the changes in liver fibrosis using the Fibrosis-4 (FIB-4) index between propensity-matched patients with and without the evidence of anti-HDV antibodies and corrected for baseline FIB-4 index, nucleoside/nucleotide analog treatment, alcohol intake, sex, HIV coinfection, liver cirrhosis, and age. After excluding patients without properly stored serums and those lacking appropriate clinical information, 601 patients with HBV were included. Of these, 1.7% of patients had detectable anti-HDV antibodies. Patients with anti-HDV antibody serum positivity had a significantly higher prevalence of liver cirrhosis, significantly lower prothrombin time, and a higher prevalence of HIV coinfection than those who demonstrated serum anti-HDV antibody negativity. A propensity-matched longitudinal analysis revealed that liver fibrosis (FIB-4 index) progressed more rapidly in patients with positive results for anti-HDV antibody tests. The recent prevalence of HDV infections in Japanese patients with HBV was 1.7% (10/601). These patients experienced rapid liver fibrosis progression, highlighting the importance of routine HDV testing.

FRI-116 - Population adjusted prevalence of hepatitis delta virus in 21 countries and territories

FRI-116 - Population adjusted prevalence of hepatitis delta virus in 21 countries and territories

Prevalence of hepatitis delta virus among chronic hbvcarriers at AOU Federico II

Prevalence of hepatitis delta virus among chronic hbvcarriers at AOU Federico II

Low prevalence of hepatitis delta infection in Cuban HBsAg carriers: Prospect for elimination.

Infection with hepatitis delta virus (HDV) is one of the most severe hepatitis B virus (HBV) complications, with a more rapid progression to cirrhosis and an increased risk of hepatic decompensation and death. Data on HDV infection in Cuba are limited. The aims of our study were to determine the HDV prevalence in HBsAg carriers and to characterize the HDV strains circulating. The data were used to assess the possibility of HDV elimination in the Cuban HBV epidemiological setting. Five hundred and two serum samples from the same number of HBsAg carriers collected in the period 2006-2019 from all over the country were tested for anti-HDV total antibodies. If positive, the samples were analyzed for HDV-RNA using Real-Time RT-PCR targeting the ribozyme and HD antigen domains followed by genotyping based on phylogenetic analysis. Two samples were anti-HDV positive [0.39% (95% CI 0.11-1.44)]. One of them was also HDV-RNA positive. Clinically, the patient with active HDV infection had compensated liver cirrhosis. Phylogenetic analysis showed that the virus belonged to genotype 1 and thus clustered with contemporary strains from North America, Europe, Middle East, and Asia. This is the first HDV study, including molecular detection and virus characterization, done after the introduction of the universal childhood anti-hepatitis B vaccination. The very low prevalence of HDV infection in HBsAg carriers combined with the high HBV vaccination coverage of all newborn children, of previously identified risk groups, and of the general population currently under 40 years of age suggests that HDV elimination is feasible in Cuba if the success in HBV control is maintained.

Prevalence of HDV infection in people living with HIV: Data from a multicenter Italian cohort.

The development of novel antiviral agents active against Hepatitis Delta Virus (HDV) might change the natural history of chronic infection, reducing the risk for end-stage liver disease. People living with HIV (PWH) are at risk for bloodborne pathogens infection, but limited data on epidemiology of HDV infection is available in this setting. The aim of this study was to investigate HDV prevalence and attitude toward HDV testing and treatment in infectious diseases centers. A cross sectional survey was performed among centers participating in the CISAI (Coordinamento Italiano per lo Studio dell'Allergia in Infezione da HIV) Group. The survey addressed anti-HDV prevalence and HDV-RNA detectability rates in PWH as well as perceived obstacles to treatment. Overall, responses from ten sites were collected. Among participating centers, 316 PWH with HBV chronic infection are currently followed. Of them, 15.2% had positive anti-HDV antibodies, while 13.9% were not tested yet. Overall, 17% of anti-HDV positive PWH tested at least once for HDV-RNA had active HDV infection, and 71% of them had advanced liver disease. Most infectious diseases centers intend to treat locally HDV infection with upcoming anti-HDV drugs, but some concerns exist regarding treatment schedule. HDV testing needs to be implemented in PWH. At present, few patients followed in the CISAI centers seem to be candidate to receive new direct active anti-HDV agents, but repeated HDV-RNA measures could change this proportion.

Hepatitis delta infection among persons living with HIV in Europe.

A high prevalence of hepatitis delta virus (HDV) infection, the most severe form of viral hepatitis, has been reported among persons living with HIV (PLWH) in Europe. We analysed data from a large HIV cohort collaboration to characterize HDV epidemiological trends across Europe, as well as its impact on clinical outcomes. All PLWH with a positive hepatitis B surface antigen (HBsAg) in the Swiss HIV Cohort Study and EuroSIDA between 1988 and 2019 were tested for anti-HDV antibodies and, if positive, for HDV RNA. Demographic and clinical characteristics at initiation of antiretroviral therapy were compared between HDV-positive and HDV-negative individuals using descriptive statistics. The associations between HDV infection and overall mortality, liver-related mortality as well as hepatocellular carcinoma (HCC) were assessed using cumulative incidence plots and cause-specific multivariable Cox regression. Of 2793 HBsAg-positive participants, 1556 (56%) had stored serum available and were included. The prevalence of HDV coinfection was 15.2% (237/1556, 95% confidence interval [CI]: 13.5%-17.1%) and 66% (132/200) of HDV-positive individuals had active HDV replication. Among persons who inject drugs (PWID), the prevalence of HDV coinfection was 50.5% (182/360, 95% CI: 45.3%-55.7%), with similar estimates across Europe, compared to 4.7% (52/1109, 95% CI: 3.5%-5.9%) among other participants. During a median follow-up of 10.8 years (interquartile range 5.6-17.8), 82 (34.6%) HDV-positive and 265 (20.1%) HDV-negative individuals died. 41.5% (34/82) of deaths were liver-related in HDV-positive individuals compared to 17.7% (47/265) in HDV-negative individuals. HDV infection was associated with overall mortality (adjusted hazard ratio 1.6; 95% CI 1.2-2.1), liver-related death (2.9, 1.6-5.0) and HCC (6.3, 2.5-16.0). We found a very high prevalence of hepatitis delta among PWID across Europe. Among PLWH who do not inject drugs, the prevalence was similar to that reported from populations without HIV. HDV coinfection was associated with liver-related mortality and HCC incidence.

Delta virus predominates and potentially predicts liver cirrhosis among co-infected hepatitis b and hepatitis d virus patients in pakistan

Background: High prevalence of Hepatitis Delta virus (HDV) has been reported from some pockets in Pakistan. Typically, Hepatitis B (HBV) and HDV co-infection could cause severe hepatitis leading to cirrhosis at an early age. We aim to study the clinical outcomes of HBV/HDV co-infection compared to HBV mono-infection in a Punjabi, Pakistani population. Methods: The retrospective data on all HBV positive patients was extracted from Hepatitis Prevention and Treatment Program (HPTP) of Pakistan Kidney and Liver Institute in Punjab, Pakistan. Majority (32/50) of the HBV/HDV co-infection were identified from Rajanpur clinic of HPTP. Pre-treatment liver tests, HBV-DNA viral load, HDV-RNA viral load; AST to Platelet ratio (APRI) and Fibrosis-4 (Fib-4) were calculated from standard equations. Cirrhosis was based on APRI (≥1.5) or/and Fib4 (≥1.45). HBV-DNA level ≤ 2,000 IU and ≥20,000 IU were categorized as low and high viral load respectively. Results: 57 (53%) patients were HBV mono-infected and 50 (47%) were co-infected with HDV. Mean age was 36.2±12.99 in the entire cohort and was not different between the two groups. Older age correlated to a higher APRI and Fib-4 scores in both groups. The two groups were predominantly male, 75% in HBV and 76% HBV/HDV co-infected patients. Sharing of toothbrushes was reported to be significantly higher by HBV mono-infected patients; p 0.005. Other risk factors were equally prevalent. 78% of HBV mono-infected and 79% HBV/HDV co-infected patients had ≤ 20,000 IU/ml HBV-DNA. While 56% and 44% had ≤ 2,000 IU/ml HBV DNA levels respectively. APRI and Fib-4 scores were significantly higher in HBV/HDV coinfected; p 0.01. The cirrhosis was diagnosed in 29 patients in HBV/HDV co-infected group, while no patient had cirrhosis in HBV mono-infected group. Within HBV/HDV co-infected group, mean HDV-viral load was significantly higher compared to HBV viral load; p 0.05. Mean HBV-DNA and HDV RNA levels in non-cirrhotics were 326411 and 35358369; and in cirrhotics 3340429 and 31867418 IU/ ml, respectively. 4 patients had undetectable HBV viral load and one of them had cirrhosis. 10 patients were cirrhotics with ≤ 2,000 IU/ml of HBV-DNA. The mean HDV RNA level in these 10 patients was 63, 000000 IU/ml. Mean HDV viral load was one log higher in patients with ≤20,000 IU/ml HBV-DNA compared to those with ≥ 20,000 IU/ml HBV-DNA viral load. Conclusion: Overall mode of transmission of HBV and HBV/HDV infections are similar in Punjab. More patients had higher liver fibrosis scores in HDV/HBV co-infected groups. The significantly low level of HBV, in the co-infected population especially cirrhotic patients indicates that liver disease is driven by HDV rather than HBV infection among co-infected Pakistani patients and Peg-interferon alone might be the best treatment option for them.

S3028 Identifying and Screening At-Risk Patients for Hepatitis Delta Virus

Introduction: Hepatitis delta virus (HDV) is associated with the most severe forms of viral hepatitis with rapid progression to cirrhosis and hepatocellular carcinoma. The prevalence of HDV may be significantly higher than formerly acknowledged in the United States, making it doubly important to identify at-risk individuals. Case Description/Methods: A recently emigrated 29-year-old Afghani male with chronic hepatitis B virus (HBV) infection presented with abdominal pain, nausea and vomiting to an outside facility. He underwent a laparoscopic cholecystectomy for symptomatic cholelithiasis. He developed postoperative abdominal distension with imaging initially concerning for a large bile leak however ERCP and a diagnostic laparoscopy were unrevealing. Four liters of fluid were drained, and a surgical drain was placed which continued to drain up to two liters of fluid daily. Upon transfer to our hospital, diagnostic workup showed AST 583 U/L, ALT 452 U/L, alkaline phosphatase 88 U/L, total bilirubin 1.8 mg/dL, and albumin 2.8 g/dL. HBV DNA PCR was < 10 IU/mL. HBV core antibodies, HBV e antibody, and HBV surface antigen were reactive. HBV e antigen and HBV surface antibody were non-reactive. Ascites fluid studies showed a high serum ascites albumin gradient and low protein, prompting a liver biopsy that showed cirrhosis (image 1). The patient was ultimately found to be positive for HDV antibody, confirming a diagnosis of cirrhosis due to HDV superinfection. The patient had his drains removed and was discharged on oral diuretics and entecavir for treatment of HBV infection. Diuretic uptitration is ongoing with plans to enroll in a trial in the future pending clinical status. Discussion: In patients with chronic HBV who acquire HDV as a superinfection, 70-80% develop cirrhosis or hepatocellular carcinoma within 5-10 years. Superinfection is the likely cause of cirrhosis in our patient, as cirrhosis in a 29-year-old would not be expected with HBV infection alone. Early recognition of at-risk individuals can aid in faster diagnosis and earlier treatment. Screening should be considered in all individuals with a reactive HBV surface antigen, and especially in migrants from endemic areas, hemodialysis patients, healthcare employees, and IV drug users. Total HDV antibodies should be obtained for screening, with diagnosis confirmation by serum RT-PCR. Currently, therapeutic options are only available for compensated patients, with pegylated interferon alpha approved in the United States and buleviritide in Europe.Figure 1.: (A) Trichrome stain showing markedly active chronic hepatitis consistent with cirrhosis. (B) Immunohistochemical stains demonstrate patchy staining with HBV surface antigen but (C) negative for HBV core antigen.

Prevalence of hepatitis B and D viruses in HIV-infected persons in the Socialist Republic of Vietnam

The aim of this study was to estimate the prevalence of hepatitis B and D viruses among HIV-infected residents of South Vietnam.Materials and methods. The study material was represented by 316 blood serum samples collected from HIV-infected residents of the Socialist Republic of Vietnam taking antiretroviral therapy. The subjects were examined for the presence of HBV markers with a qualitative detection of HBsAg, HBs IgG, HBcore IgG, anti-HDV, DNA HBV, and RNA HDV. HBV and HDV complete genomes nucleotide sequences were obtained for 23 samples from HIV+HBV+HDV co-infected patients. Amplification and subsequent sequencing of HBV and HDV were performed using nested PCR with pair’s overlapping primers jointly flanking the complete HBV and HDV genomes, respectively.Results. Serological markers of HBV and HDV were presented in the following ratios: HBsAg — 9.17%, anti-HBs Ig G — 10.44%, anti-HBcore Ig G — 42.08%, total anti-HDV — 9.81%. HBV DNA was detected in 32.58% of cases, including 23.41% of HBsAg-negative individuals. HDV RNA was detected in 24.13% of HBsAg-positive individuals and 21.62% of HBsAg-negative, which amounted to 22.33% of HBV-positive individuals and 7.27% of the total group, respectively. In phylogenetic analysis, HBV subgenotype B4 (60.89%) prevailed among HIV-infected patients compared to C1 (21.73%), B2 (8.7%), C2 (4.34%) and C5 (4.34%). Phylogenetic analysis of HDV nucleotide sequences showed the prevalence of HDV genotype 1 (78.26%) compared to genotype 2 (21.74%). The hepatitis Delta virus prevalence in patients with HIV+HBV coinfection, and the prevalence of seronegative HDV in patients with OBI indicate the need to use PCR in hepatitis highly endemic regions for hepatitis B and hepatitis D screening of the general population and especially those at-risk groups.

Prevalence of Hepatitis D virus antibodies in Hepatitis B patients treated at tertiary care unit at Jabalpur Central India

Hepatitis Delta virus (HDV) infection amongst Hepatitis B virus (HBV) infected patients increases morbidity and mortality. The prevalence varies temporally and spatially. The present study aimed to evaluate the HDV prevalence in central India. Samples received from January 2018 to December 2019 were tested for viral hepatitis markers. Randomly picked 372 HBsAg positive samples were tested for the presence of HDV total antibodies using ELISA, of these 8 were found positive. This study for the first-time documents presence of HDV with 2.1% prevalence from central India. We recommend screening for better patient management and bringing down the disease burden.