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Foupouapouognigni Y, Mfonkou JDT, Boyomo O, Gessain A, Njouom R. Endemicity and genetic diversity of Hepatitis delta virus among Pygmies in Cameroon, Central Africa. BMC Res Notes 2022; 15:87. [PMID: 35241131 PMCID: PMC8895529 DOI: 10.1186/s13104-022-05976-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/16/2022] [Indexed: 08/30/2023] Open
Abstract
OBJECTIVE A single study conducted about three decades ago on hepatitis D virus (HDV) infection among Baka pygmies in Cameroon reported a very high anti-HDV antibodies prevalence of 46%, but HDV genetic diversity has not been studied in this population. The genetic diversity of strains from endemic ancient populations may help to understand the origin and evolutionary history of viruses. This study aimed to investigate the HDV seroprevalence and the genetic diversity in three remote Cameroonian Pygmies with chronic HBV infection. RESULTS An unusually high 69% (36/52) level of HDV infection was found among HBsAg-positive pygmies in Cameroon. HDV RNA was detected and sequenced in 38.8% (14/36). The phylogenetic analysis revealed that 9/14 strains (64.3%) were identified and classified as genotype 1 (HDV-1) and 5/14 (35.6%) as genotype 7 (HDV-7), respectively with a bootstrap value of 100%. The further analysis showed the co-circulation of highly diverse HDV genotypes HDV-1 and HDV-7 in this population. These results highlight the endemicity of HDV infection in Central Africa. The highly diverse HDV-1 and HDV-7 in pygmies suggest an African origin of HDV. However, further studies are needed with larger sample size.
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Affiliation(s)
| | - Jacques Delors Toumansie Mfonkou
- Virology Service, Centre Pasteur of Cameroon, BP 1274, Yaoundé, Cameroon.,Laboratory of Microbiology, University of Yaounde I, BP 812, Yaoundé, Cameroon
| | - Onana Boyomo
- Laboratory of Microbiology, University of Yaounde I, BP 812, Yaoundé, Cameroon
| | - Antoine Gessain
- Unit of Epidemiology and Physiopathology of Oncogenic Viruses, URA CNRS 3015, Department of Virology, Institut Pasteur, 25-28 rue du Dr Roux, 75724, Paris Cedex 15, France
| | - Richard Njouom
- Virology Service, Centre Pasteur of Cameroon, BP 1274, Yaoundé, Cameroon.
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Besombes C, Njouom R, Paireau J, Lachenal G, Texier G, Tejiokem M, Cauchemez S, Pépin J, Fontanet A. The epidemiology of hepatitis delta virus infection in Cameroon. Gut 2020; 69:1294-1300. [PMID: 31907297 DOI: 10.1136/gutjnl-2019-320027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/22/2019] [Accepted: 12/20/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To investigate the distribution and risk factors of hepatitis delta virus (HDV) infection in Cameroon. DESIGN We tested for hepatitis B virus (HBV) surface antigen (HBsAg) and anti-HDV antibody 14 150 samples collected during a survey whose participants were representative of the Cameroonian adult population. The samples had already been tested for hepatitis C virus and HIV antibodies. RESULTS Overall, 1621/14 150 (weighted prevalence=11.9%) participants were HBsAg positive, among whom 224/1621 (10.6%) were anti-HDV positive. In 2011, the estimated numbers of HBsAg positive and HDV seropositives were 1 160 799 and 122 910 in the 15-49 years age group, respectively. There were substantial regional variations in prevalence of chronic HBV infection, but even more so for HDV (from 1% to 54%). In multivariable analysis, HDV seropositivity was independently associated with living with an HDV-seropositive person (OR=8.80; 95% CI: 3.23 to 24.0), being HIV infected (OR=2.82; 95% CI: 1.32 to 6.02) and living in the South (latitude <4°N) while having rural/outdoor work (OR=15.2; 95% CI: 8.35 to 27.6, when compared with living on latitude ≥4°N and not having rural/outdoor work). CONCLUSION We found evidence for effective intra-household transmission of HDV in Cameroon. We also identified large differences in prevalence between regions, with cases concentrated in forested areas close to the Equator, as described in other tropical areas. The reasons underlying these geographical variations in HDV prevalence deserve further investigation.
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Affiliation(s)
- Camille Besombes
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France
| | - Richard Njouom
- Department of Virology, Centre Pasteur du Cameroun, Yaounde, Cameroon
| | - Juliette Paireau
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
| | | | - Gaëtan Texier
- Department of Epidemiology and Public Health, Centre Pasteur du Cameroun, Yaounde, Cameroon
| | - Mathurin Tejiokem
- Department of Epidemiology and Public Health, Centre Pasteur du Cameroun, Yaounde, Cameroon
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France.,UMR2000, CNRS, Paris, France
| | - Jacques Pépin
- Department of Microbiology and Infectious Diseases, Sherbrooke University, Sherbrooke, Quebec, Canada
| | - Arnaud Fontanet
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France .,PACRI Unit, Conservatoire National des Arts et Métiers, Paris, France
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Spaan M, Carey I, Bruce M, Shang D, Horner M, Dusheiko G, Agarwal K. Hepatitis delta genotype 5 is associated with favourable disease outcome and better response to treatment compared to genotype 1. J Hepatol 2020; 72:1097-1104. [PMID: 31981726 DOI: 10.1016/j.jhep.2019.12.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 12/29/2019] [Accepted: 12/31/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND & AIMS Coinfection with HDV causes rapid progression to liver cirrhosis and hepatic decompensation in patients with chronic hepatitis B. Factors that are associated with disease progression are poorly understood. In this study we aim to identify risk factors associated with disease progression and better characterise clinical differences and treatment response between HDV genotype 1 and 5. METHODS In this retrospective study, all patients under our care between 2005 and 2016 with HBV/HDV coinfection (HBsAg+, anti-HDV antibodies positive) were analysed. Patients were excluded if follow-up was less than 6 months, if they had HCV and/or HIV coinfection or an acute HDV infection. Demographic data, stage of liver disease, development of liver complications and treatment response were recorded. RESULTS One-hundred seven patients (mean age 36.0 years, 57% male) were followed for a median period of 4.4 years (range 0.6-28.1 years); 64% were of African origin and 17% were of European origin, with 28% of patients being cirrhotic at first visit; 43% patients had actively replicating HDV virus (anti-HDV-IgG+, anti-HDV-IgM+ or HDV RNA+) and 57% of patients were HDV exposed (anti-HDV-IgG+, HDV RNA-). Patients with actively replicating HDV more often developed liver complications than HDV-exposed patients (p = 0.002), but no differences in baseline characteristics were observed. Patients with HDV genotype 5 less often developed cirrhosis or hepatic decompensation compared to patients with HDV genotype 1. Twenty-four patients were treated with peg-IFN and post-treatment response was significantly better in patients infected with genotype 5 (10% GT1 vs. 64% GT5, p = 0.013). CONCLUSION Patients infected with HDV genotype 5 appear to have a better prognosis with fewer episodes of hepatic decompensation and better response to peg-IFN treatment than patients infected with HDV genotype 1. LAY SUMMARY Hepatitis delta is a virus that affects the liver. The virus is known to have different subtypes, called genotypes. With this research we discovered that hepatitis delta virus genotype 1 behaves differently than genotype 5 and causes faster development of liver disease. This is important for education of our patients and to determine how often we need to check our patients.
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Affiliation(s)
- Michelle Spaan
- Institute of Liver Studies, King's College Hospital, London, United Kingdom; Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands.
| | - Ivana Carey
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Matthew Bruce
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Dazhuang Shang
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Mary Horner
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Geoff Dusheiko
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Kosh Agarwal
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
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Sharafi H, Rezaee-Zavareh MS, Miri SM, Alavian SM. Global Distribution of Hepatitis D Virus Genotypes: A Systematic Review. HEPATITIS MONTHLY 2020; 20. [DOI: 10.5812/hepatmon.102268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
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Noubissi-Jouegouo L, Atsama MA, Tagnouokam-Ngoupo PA, Monamele CG, Ngono L, Njouom R. Evolutionary trends in the prevalence of anti-HDV antibodies among patients positive for HBsAg referred to a national laboratory in Cameroon from 2012 to 2017. BMC Res Notes 2019; 12:417. [PMID: 31307546 PMCID: PMC6631665 DOI: 10.1186/s13104-019-4460-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/09/2019] [Indexed: 12/11/2022] Open
Abstract
Objective The aim of this study was to update the data on the prevalence of anti-HDV antibodies in Cameroon. Results Antibodies against hepatitis Delta virus (Anti-HDV) were found in 16.48% (95% CI 11.46–18.77%) of 426 hepatitis B virus surface antigen positive patients in Cameroon. Remarkably, they were significantly higher among people over 40 years and those living in the East and South regions of Cameroon at 66.7%, 50%, and 40%, respectively. These results suggest that older age and living in areas in the dense forest may be risk factors for Hepatitis D infection.
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Affiliation(s)
- Laurence Noubissi-Jouegouo
- Virology Department, Centre Pasteur of Cameroon, Po Box 1274, Yaoundé, Cameroon.,School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
| | | | | | | | - Laure Ngono
- Virology Department, Centre Pasteur of Cameroon, Po Box 1274, Yaoundé, Cameroon
| | - Richard Njouom
- Virology Department, Centre Pasteur of Cameroon, Po Box 1274, Yaoundé, Cameroon.
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Jackson K, MacLachlan J, Cowie B, Locarnini S, Bowden S, Higgins N, Karapanagiotidis T, Nicholson S, Littlejohn M. Epidemiology and phylogenetic analysis of hepatitis D virus infection in Australia. Intern Med J 2019; 48:1308-1317. [PMID: 29761607 DOI: 10.1111/imj.13967] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/08/2018] [Accepted: 05/08/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The incidence and trends of the hepatitis D virus (HDV) in Australia have not been recently assessed, and the circulating genotypes have never been determined. AIM To characterise the current virology and epidemiology of HDV. METHODS Notifiable disease surveillance and laboratory testing data were analysed to assess demographics, risk factors and trends. HDV serology and RNA testing were performed on requested samples from 2010 to 2016. Sequencing of a 500-nucleotide amplicon of the delta antigen and phylogenetic analysis of the strains from 2009 to 2016 were also conducted. RESULTS Ninety HDV notifications were reported to the Victorian Department of Health and Human Services between 2010 and 2016. The majority (64.4%) of those diagnosed were born overseas, most commonly in Sudan, Pakistan and Vietnam. Over the same period, 190 patients tested positive for anti-HDV serology and 166 for HDV RNA. Sequencing of isolates from 169 individuals between 2009 and 2016 found that 80.5% strains were genotype 1, 16% genotype 5 and 3.5% genotype 2. Phylogenetic analysis confirmed the relatedness of strains from birth country, demonstrated the presence of the 'Pacific Island' genotype 1 strain in Queensland and supported possible transmission in correctional facilities and within families. CONCLUSIONS This study demonstrates the ongoing need for routine HDV screening and engagement in clinical care for people living with HBV in Australia. Epidemiological findings highlight the diversity in those affected and provide insights into local and global geographic distribution and transmission patterns.
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Affiliation(s)
- Kathy Jackson
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Jennifer MacLachlan
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Benjamin Cowie
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Stephen Locarnini
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Scott Bowden
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Nasra Higgins
- Department of Health and Human Services Victoria, Melbourne, Victoria, Australia
| | - Theo Karapanagiotidis
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Suellen Nicholson
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Margaret Littlejohn
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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Groc S, Abbate JL, Le Gal F, Gerber A, Tuaillon E, Albert JL, Nkoghé D, Leroy EM, Roche B, Becquart P. High prevalence and diversity of hepatitis B and hepatitis delta virus in Gabon. J Viral Hepat 2019; 26:170-182. [PMID: 30141209 DOI: 10.1111/jvh.12991] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/28/2018] [Accepted: 07/23/2018] [Indexed: 12/15/2022]
Abstract
Although central Africa is classified as having a high endemicity of hepatitis B virus (HBV) and hepatitis D virus (HDV) infection, there is paucity of prevalence studies. For the first time on a country-wide level in Central Africa, we show in Gabon an overall 7.4% prevalence of Hepatitis B surface antigen (HBsAg) and that more than 25% of the HBsAg-positive population are infected by HDV. Although HBV prevalence did not differ significantly between provinces, there is a north-south split in the distribution of HDV seroprevalence, with the highest rates (>66.0%) correlating with the presence of specific ethnic groups in the northeastern provinces. Genotyping revealed high genetic diversity of the HBV and HDV strains circulating in Gabon, including many restricted to this region of the globe. This work confirmed that high exposure to HBV and HDV infection reported in selected regions of Gabon holds true across the whole country.
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Affiliation(s)
- Soraya Groc
- MIVEGEC, IRD/CNRS/Univ. Montpellier, Montpellier, France
| | - Jessica Lee Abbate
- MIVEGEC, IRD/CNRS/Univ. Montpellier, Montpellier, France.,UMR UMMISCO (UMI 209 IRD-UPMC), Bondy, France
| | - Frédéric Le Gal
- Laboratoire de Microbiologie Clinique, Hôpital Avicenne, Centre National de Référence des Virus des Hépatites B C et Delta, Bobigny, France.,Unité INSERM U955, Equipe 18, Créteil, France
| | - Athenaïs Gerber
- Laboratoire de Microbiologie Clinique, Hôpital Avicenne, Centre National de Référence des Virus des Hépatites B C et Delta, Bobigny, France
| | - Edouard Tuaillon
- Pathogenesis and Control of Chronic Infections, Inserm U1058, University of Montpellier, Montpellier, France.,CHU de Montpellier, Montpellier, France
| | - Jean-Louis Albert
- Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
| | - Dieudonné Nkoghé
- Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
| | - Eric M Leroy
- MIVEGEC, IRD/CNRS/Univ. Montpellier, Montpellier, France.,Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
| | - Benjamin Roche
- MIVEGEC, IRD/CNRS/Univ. Montpellier, Montpellier, France.,UMR UMMISCO (UMI 209 IRD-UPMC), Bondy, France
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Koh C, Heller T, Glenn JS. Pathogenesis of and New Therapies for Hepatitis D. Gastroenterology 2019; 156:461-476.e1. [PMID: 30342879 PMCID: PMC6340762 DOI: 10.1053/j.gastro.2018.09.058] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 12/13/2022]
Abstract
Hepatitis delta virus (HDV) infection of humans was first reported in 1977, and now it is now estimated that 15-20 million people are infected worldwide. Infection with HDV can be an acute or chronic process that occurs only in patients with an hepatitis B virus infection. Chronic HDV infection commonly results in the most rapidly progressive form of viral hepatitis; it is the chronic viral infection that is most likely to lead to cirrhosis, and it is associated with an increased risk of hepatocellular carcinoma. HDV infection is the only chronic human hepatitis virus infection without a therapy approved by the US Food and Drug Administration. Peginterferon alfa is the only recommended therapy, but it produces unsatisfactory results. We review therapeutic agents in development, designed to disrupt the HDV life cycle, that might benefit patients with this devastating disease.
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Affiliation(s)
- Christopher Koh
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
| | - Theo Heller
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Jeffrey S. Glenn
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
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SHARIFAN P, AMOUEIAN S. Histological and Serological Epidemiology of Hepatitis Delta Virus Coinfection among Patients with Chronic Active Hepatitis B Virus in Razavi Khorasan Province, Northeastern Iran. IRANIAN JOURNAL OF PUBLIC HEALTH 2018; 47:1906-1912. [PMID: 30788306 PMCID: PMC6379606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Hepatitis delta virus (HDV), as well as hepatitis B virus (HBV), are regarded as one of the main public health issues in developing countries. This retrospective study described histological and serological features of HDV coinfection patients with chronic active HBV in Northeastern Iran. METHODS The frequency of HDV seropositivity and its impact on serum liver enzyme levels and pathological features were investigated by reviewing clinical and laboratory data. This study contained chronic active HBV-infected patients having admitted the department during 2009 and 2014. RESULTS The rate of HDV coinfection in chronic active carriers was 21.84%, with a male predominance. HDV seropositive carriers showed significantly higher concentrations of liver enzyme than chronic active HBV monoinfection. Moreover, there was a strong association between degrees of inflammation with HDV-positive patients' enzyme levels. CONCLUSION The HDV seroprevalence in northeastern Iran was higher than that reported from elsewhere in Iran while comparable to some regions in Middle East, which, in turn, requires more comprehensive tools for diagnosing and screening the blood.
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Transmission of Hepatitis B and D Viruses in an African Rural Community. mSystems 2018; 3:mSystems00120-18. [PMID: 30246145 PMCID: PMC6143728 DOI: 10.1128/msystems.00120-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/21/2018] [Indexed: 12/12/2022] Open
Abstract
According to the World Health Organization (WHO), an estimated 257 million people worldwide are chronically infected with hepatitis B virus (HBV), with approximately 15 million of them being coinfected with hepatitis D virus (HDV). To investigate the prevalence and transmission of HBV and HDV within the general population of a rural village in Cameroon, we analyzed serum samples from most (401/448) of the villagers. HBV surface antigen (HBsAg) was detected in 54 (13.5%) of the 401 samples, with 15% of them also containing anti-HDV antibodies. Although Cameroon has integrated HBV vaccination into their Expanded Program on Immunization for newborns in 2005, an HBsAg carriage rate of 5% was found in children below the age of 5 years. Of the 54 HBsAg-positive samples, 49 HBV pre-S/S sequences (7 genotype A and 42 genotype E sequences) could be amplified by PCR. In spite of the extreme geographical restriction in the recruitment of study participants, a remarkable genetic diversity within HBV genotypes was observed. Phylogenetic analysis of the sequences obtained from PCR products combined with demographic information revealed that the presence of some genetic variants was restricted to members of one household, indicative of intrafamilial transmission, which appears to take place at least in part perinatally from mother to child. Other genetic variants were more widely distributed, reflecting horizontal interhousehold transmission. Data for two households with more than one HBV-HDV-coinfected individual indicate that the two viruses are not necessarily transmitted together, as family members with identical HBV sequences had different HDV statuses. IMPORTANCE This study revealed that the prevalence of HBV and HDV in a rural area of Cameroon is extremely high, underlining the pressing need for the improvement of control strategies. Systematic serological and phylogenetic analyses of HBV sequences turned out to be useful tools to identify networks of virus transmission within and between households. The high HBsAg carriage rate found among children demonstrates that implementation of the HBV birth dose vaccine and improvement of vaccine coverage will be key elements in preventing both HBV and HDV infections. In addition, the high HBsAg carriage rate in adolescents and adults emphasizes the need for identification of chronically infected individuals and linkage to WHO-recommended treatment to prevent progression to liver cirrhosis and hepatocellular carcinoma.
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High prevalence of hepatitis delta virus in Cameroon. Sci Rep 2018; 8:11617. [PMID: 30072752 PMCID: PMC6072717 DOI: 10.1038/s41598-018-30078-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/29/2018] [Indexed: 02/07/2023] Open
Abstract
Hepatitis delta virus (HDV), a satellite virus of hepatitis B virus (HBV), infects an estimated 15–20 million people worldwide and confers a greater risk for accelerated progression to liver disease. However, limited HDV surveillance data are available in sub-Saharan Africa where HDV diversity is high. To determine the prevalence and diversity of HDV in Cameroon, serological and molecular characterization was performed on 1928 HBsAg positive specimens selected from retrospective viral surveillance studies conducted in Cameroon from 2010–2016. Samples were screened for HDV antibodies on the Abbott ARCHITECT instrument and for HDV RNA on the Abbott m2000 instrument by research assays. HDV positive specimens with sufficient viral load were selected for genomic sequencing. The seroprevalence of HDV in HBsAg positive samples from Cameroon was 46.73% [95% CI; 44.51–48.96%], with prevalence of active HDV infection being 34.2% [95% CI; 32.09–36.41%]. HDV genotypes 1, 6, 7 and 8 were identified amongst N = 211 sequences, including N = 145 genomes. HDV prevalence is high within the study cohort, indicating that a large portion of HBV infected individuals in Cameroon are at elevated risk for severe hepatitis and death. Collectively, these results emphasize the need for HBV vaccination and HDV testing in HBsAg positive patients in Cameroon.
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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: 83] [Impact Index Per Article: 13.8] [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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Luma HN, Eloumou SA, Okalla C, Donfack-Sontsa O, Koumitana R, Malongue A, Nko’Ayissi GB, Noah DN. Prevalence and Characteristics of Hepatitis Delta Virus Infection in a Tertiary Hospital Setting in Cameroon. J Clin Exp Hepatol 2017; 7:334-339. [PMID: 29234199 PMCID: PMC5715454 DOI: 10.1016/j.jceh.2017.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/15/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/AIMS Hepatitis B virus (HBV) and hepatitis D virus (HDV) coinfection is associated with more severe liver disease than HBV alone. More knowledge on the epidemiology and clinical impact of HDV-infected individuals is needed in Cameroon.We aimed at determining the frequency of anti-HDV antibody testing in hepatitis B surface antigen (HBsAg) positive patients, the proportion of anti-HDV positivity, and the characteristics of anti-HDV positive compared to anti-HDV negative patients in a tertiary hospital setting in Cameroon. METHODS A cross-sectional study was conducted. Clinical records of chronic HBV-infected patients attending the gastroenterology unit at the Douala General Hospital from 2010 to 2014 were reviewed. RESULTS Of 365 files of HBsAg-positive patients defined as chronic HBV infection, 80.5% (294) were tested for anti-HDV antibodies, among whom 10.5% (31/294) were positive. Median aspartate aminotransferase (P < 0.0001), alanine aminotransferase (P < 0.0001), and gamma glutaryl transpeptidase (P < 0.0001) were significantly higher while platelets count (P < 0.002) and prothrombin time (P < 0.0001) were significantly lower in anti-HDV positive compared to anti-HDV negative patients. Liver necroinflammation (P < 0.0001), fibrosis score (P < 0.0001), and decompensated cirrhosis (P < 0.0001) were also significantly associated with anti-HDV positivity. CONCLUSION The proportion of anti-HDV antibody positivity remains high in this setting and was significantly associated with more severe liver disease compared to those who were anti-HDV negative. More studies are needed to evaluate rates of HDV testing in other centers in Cameroon and the subregion. Preventive strategies for HBV prevention, which also apply to HDV, must still be reinforced by healthcare providers and policy makers.
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Key Words
- AFP, alpha-fetoproteins
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- Cameroon
- ELISA, enzyme-linked immunosorbent assay
- GGT, gamma glutaryl transpeptidase
- HBV
- HBV, hepatitis B virus
- HBe ab, hepatitis B e antibody
- HBeAg, hepatitis B e antigen
- HBsAg, hepatitis B surface antigen
- HCC, hepatocellular carcinoma
- HDV
- HDV, hepatitis delta virus
- HIV, human immunodeficiency virus
- PT, prothrombin time
- fibrosis
- testing
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Affiliation(s)
- Henry N. Luma
- Internal Medicine Service, Douala General Hospital, Douala, Cameroon,Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon,Address for correspondence: Henry Namme Luma, P.O. Box 4856, Douala, Cameroon. Tel.: +237 699960059; fax: +237 243 37 01 46.Henry Namme Luma, P.O. Box 4856DoualaCameroon
| | - Servais A.F.B. Eloumou
- Internal Medicine Service, Douala General Hospital, Douala, Cameroon,Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Cécile Okalla
- Internal Medicine Service, Douala General Hospital, Douala, Cameroon,Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | | | - Ruth Koumitana
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Agnes Malongue
- Internal Medicine Service, Douala General Hospital, Douala, Cameroon
| | | | - Dominique N. Noah
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
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High Prevalence and Diversity of Hepatitis Viruses in Suspected Cases of Yellow Fever in the Democratic Republic of Congo. J Clin Microbiol 2017; 55:1299-1312. [PMID: 28202798 PMCID: PMC5405249 DOI: 10.1128/jcm.01847-16] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 02/02/2017] [Indexed: 12/22/2022] Open
Abstract
The majority of patients with acute febrile jaundice (>95%) identified through a yellow fever surveillance program in the Democratic Republic of Congo (DRC) test negative for antibodies against yellow fever virus. However, no etiological investigation has ever been carried out on these patients. Here, we tested for hepatitis A (HAV), hepatitis B (HBV), hepatitis C (HCV), hepatitis D (HDV), and hepatitis E (HEV) viruses, all of which can cause acute febrile jaundice, in patients included in the yellow fever surveillance program in the DRC. On a total of 498 serum samples collected from suspected cases of yellow fever from January 2003 to January 2012, enzyme-linked immunosorbent assay (ELISA) techniques were used to screen for antibodies against HAV (IgM) and HEV (IgM) and for antigens and antibodies against HBV (HBsAg and anti-hepatitis B core protein [HBc] IgM, respectively), HCV, and HDV. Viral loads and genotypes were determined for HBV and HVD. Viral hepatitis serological markers were diagnosed in 218 (43.7%) patients. The seroprevalences were 16.7% for HAV, 24.6% for HBV, 2.3% for HCV, and 10.4% for HEV, and 26.1% of HBV-positive patients were also infected with HDV. Median viral loads were 4.19 × 105 IU/ml for HBV (range, 769 to 9.82 × 109 IU/ml) and 1.4 × 106 IU/ml for HDV (range, 3.1 × 102 to 2.9 × 108 IU/ml). Genotypes A, E, and D of HBV and genotype 1 of HDV were detected. These high hepatitis prevalence rates highlight the necessity to include screening for hepatitis viruses in the yellow fever surveillance program in the DRC.
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16
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Jamjoom GA, El-Daly MM, Azhar EI, Fallatah HI, Akbar HO, Babatin M, Alghamdi AS, Dgdgi MI, Hamid MA, Qari YA, El-Kafrawy SA. Prevalence and molecular characterization of hepatitis D virus in Saudi Arabia: A single-center study. Saudi J Gastroenterol 2017; 23:176-182. [PMID: 28611341 PMCID: PMC5470377 DOI: 10.4103/sjg.sjg_515_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND/AIMS Hepatitis D virus (HDV) is a defective RNA virus that is dependent on hepatitis B surface antigen (HBsAg) for transmission and replication. HDV significance arises from the possibility of poor prognosis of hepatitis B virus (HBV) infection. In Saudi Arabia, HDV prevalence varied from 8 to 32% before the HBV vaccination program and ranged from 0 to 14.7% after the vaccination program was started. The last study, performed in 2004, showed a prevalence of 8.6% in hospital-based HBV cases and 3.3% in healthy donors. The aim of this study was to investigate the prevalence and molecular characterization of HDV in chronic hepatitis B (CHB) patients at the King Abdulaziz University Hospital in Jeddah, Saudi Arabia by molecular and serological techniques. To the best of our knowledge, this is the first study to detect HDV at the molecular level in Saudi Arabia. PATIENTS AND METHODS The study included samples from 182 CHB patients from Jeddah; 13 samples with HBsAg negative were excluded. Samples were tested for HDV-Ab, viral RNA by reverse transcriptase-polymerase chain reaction (RT-PCR) in the HDV L-Ag region and sequence analysis. RESULTS The mean age of the participants was 44.36 years; 75.1% of the participants were Saudi nationals, 58% were males. Nine samples were positive for HDV-Ab and four were borderline; all were subjected to RT-PCR amplification. Three of the positive HDV-Ab cases and 1 borderline case were positive by RT-PCR. All the positive cases had HBV genotype D, and the positive RT-PCR cases were positive for HBV DNA. One of the HDV viremic samples was of genotype 1 by sequencing. The prevalence of HDV in the study was 7.7%, which was lower in Saudis (6.3%) than in non-Saudis (11.9%). CONCLUSION HDV coinfection does not seem to have an effect on the clinical status of the recruited CHB cases in this study. More studies are needed to investigate the genetic diversity in other areas such as the southern parts of the Kingdom.
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Affiliation(s)
- Ghazi A. Jamjoom
- Special Infectious Agent Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mai M. El-Daly
- Special Infectious Agent Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Esam I. Azhar
- Special Infectious Agent Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hind I. Fallatah
- Unit of Gastroenterology and Hepatology, Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hisham O. Akbar
- Unit of Gastroenterology and Hepatology, Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | | | - Mohammed I. Dgdgi
- Gastroenterology Department, King Fahd Central Hospital, Jizan, Saudi Arabia
| | - Mohamed A. Hamid
- Viral Hepatitis Research Laboratory, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt,Department of Microbiology and Immunology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Yousef A. Qari
- Department of Medicine, Section of Gastroenterology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Sherif A. El-Kafrawy
- Special Infectious Agent Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia,Address for correspondence: Dr. Sherif A. El-Kafrawy, Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah - 21589, Saudi Arabia. E-mail:
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17
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Abstract
Hepatitis D is caused by the hepatitis D virus (HDV), a unique RNA pathogen that requires the hepatitis B surface antigen (HBsAg) to infect. Hepatitis D is transmitted by the parenteral route. The main susceptible group is patients with chronic HBsAg infection who become superinfected with the virus. Hepatitis D occurs throughout the globe, but control of hepatitis B virus (HBV) in the last two decades has consistently diminished the circulation of HDV in industrialized countries. However, hepatitis D remains a medical issue for injecting drug users (IDUs), as well as immigrants from endemic HDV areas, who are reintroducing the infection in Europe.
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Affiliation(s)
- Mario Rizzetto
- Division of Gastroenterology, University of Torino, 10126 Torino, Italy
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18
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Sadeghian H, Varasteh N, Esmaeelzadeh A, Nomani H, Alimardani M, Davoodnejad M, Meshkat M, Ahadi M, Sepahi S, Rostami S, Meshkat Z. Distribution of hepatitis delta virus genotypes in mashhad, northeast iran. Jundishapur J Microbiol 2015; 8:e14908. [PMID: 25793092 PMCID: PMC4353030 DOI: 10.5812/jjm.14908] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 11/17/2013] [Accepted: 12/25/2013] [Indexed: 12/29/2022] Open
Abstract
Background: Hepatitis delta virus (HDV) is dependent on the hepatitis B virus for transmission and propagation. Based on isolated HDV sequences from different parts of the world, at least three major different genotypes with different geographic distributions are suggested. Studies have shown that genotype 1 is the predominant genotype of HDV in different parts of Iran; however, the genotype distribution of this virus has not been identified in Mashhad, northeast Iran. Objectives: This current study determines the frequency of HDV major genotypes in Mashhad, Iran. Patients and Methods: Twenty-five participants were enrolled in this study. All samples were positive for HBsAg (determined by Enzyme-linked immunosorbent assay (ELISA)) and anti-HDV. RNA extraction and cDNA synthesis was performed. Then, PCR was performed and HDV genotypes were determined by restriction fragment length polymorphism (RFLP). Results: Of 25 patients, 12 (48%) were positive for HDV RNA. Genotype analysis of HDV RNA revealed that the prevalence of HDV genotypes I and II was 83.3% (n = 10) and 16.7% (n = 2), respectively. Conclusions: This study showed that the most prevalent genotype of HDV in Mashhad was genotype I. It was of interest that in contrast to other provinces of Iran, HDV genotype 2 was observed in Mashhad. Similar studies with larger sample sizes could provide valuable information regarding the molecular epidemiology and geographical distribution. It may also help control and prevent the spread of hepatitis D virus infections. In addition, the genotyping of HDV may predict the severity of the disease.
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Affiliation(s)
- Hamid Sadeghian
- Department of Laboratory Sciences, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Naiemeh Varasteh
- School of Medicine, Islamic Azad University, Mashhad Branch, Mashhad, IR Iran
| | - Abbas Esmaeelzadeh
- Department of Internal Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Hosein Nomani
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Maliheh Alimardani
- Department of Laboratory Sciences, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mahdieh Davoodnejad
- Department of Human Genetic, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mojtaba Meshkat
- Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mitra Ahadi
- Department of Internal Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Samaneh Sepahi
- Targeted Drug Delivery Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Sina Rostami
- Department of Biology, Faculty of Sciences, Ferdowsi University of Mashhad, Mashhad, IR Iran
| | - Zahra Meshkat
- Department of Human Genetic, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding author: Zahra Meshkat, Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-5118012453, Fax: +98-5118002960, E-mail:
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19
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Braga WSM, de Oliveira CMC, de Araújo JR, Castilho MDC, Rocha JM, Gimaque JBDL, Silva MLCR, Vasconcelos HL, Ramasawmy R, Paraná R. Chronic HDV/HBV co-infection: predictors of disease stage---a case series of HDV-3 patients. J Hepatol 2014; 61:1205-11. [PMID: 24905491 DOI: 10.1016/j.jhep.2014.05.041] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Chronic HDV/HBV co-infection is perhaps the most intriguing amongst all viral hepatitis. Only few studies focus deeply on this topic, particularly with patients infected with HDV-3. This study aimed to identify predictors of advanced disease, examining a cross-sectional data of 64 patients. METHODS Histological grading was used to characterize the disease stages and viral loads were tested as predictors of necroinflammatory activity and fibrosis. RESULTS We identified three HDV/HBV co-infection patterns: patients with predominant HDV replication (56.3%), patients with similar viral loads of both viruses (40.6%), and patients with predominant HBV replication (3.1%). Mean HDV-RNA showed a positive trend regarding inflammatory activity and grade of fibrosis. HDV viral load correlated positively with serum levels of liver enzymes and inversely with platelets count. HBV viral load showed no correlation with any of the above parameters. Advanced fibrosis was associated with age, splenomegaly, and HDV viral load of more than 2 log10. Multiple logistic regression confirmed the independent effect of HDV viral predominance. Advanced necroinflammatory activity was independently associated with HDV viral load and splenomegaly. CONCLUSIONS HDV may possibly play an important and direct role in the establishment of necroinflammatory activity and fibrosis. Data show an indigenous HDV genotype, HDV-3, similar to those described in the Amazon region.
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Affiliation(s)
| | - Cintia Mara Costa de Oliveira
- Virology Department, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil; Multidisciplinar Center, Federal University of Amazonas, Manaus, Amazonas, Brazil
| | - José Ribamar de Araújo
- Anatomopatology Department, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Marcia da Costa Castilho
- Virology Department, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Joelma Martins Rocha
- Virology Department, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | | | | | - Heline Lira Vasconcelos
- Virology Department, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Rajendranath Ramasawmy
- Virology Department, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil; Nilton Lins University, Manaus, Amazonas, Brazil
| | - Raymundo Paraná
- Gastroenterology Unit, Federal University of Bahia, Salvador, Bahia, Brazil
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20
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Azarbahra M, Tajbakhsh E, Momtaz H. Phylogenetic analysis of hepatitis delta virus isolated from HBsAg positive patients in Shahrekord, Iran. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2014. [DOI: 10.1016/s2222-1808(14)60593-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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21
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Matthews PC, Geretti AM, Goulder PJR, Klenerman P. Epidemiology and impact of HIV coinfection with hepatitis B and hepatitis C viruses in Sub-Saharan Africa. J Clin Virol 2014; 61:20-33. [PMID: 24973812 DOI: 10.1016/j.jcv.2014.05.018] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 05/22/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023]
Abstract
Human immunodeficiency virus (HIV), Hepatitis B (HBV) and Hepatitis C (HCV) are blood-borne viruses with potentially shared routes of transmission. In high-income settings, the impact of antiretroviral therapy (ART) on survival has unmasked chronic liver disease from viral hepatitis B or hepatitis C as a leading cause of morbidity and mortality in individuals with HIV infection. It is now feared that progressive liver disease may threaten the success of ART programmes in developing countries, where HCV or HBV testing and monitoring are not yet systematic among HIV-infected patients and ART use is generally blind to these co-infections. We set out to review recent data from Sub-Saharan Africa, in order to build a detailed and up-to-date picture of the epidemiology and emerging impact of HBV and HCV coinfection in countries at the heart of the HIV pandemic. There is a preponderance of HIV/HBV coinfection compared to HIV/HCV in this region, and significant caveats exist regarding the accuracy of published HCV seroprevalence surveys. Morbidity and mortality of coinfection is significant, and may be further enhanced in African populations due to the influence of host, viral and environmental factors. Careful scrutiny of the coinfection problem is vital to inform an approach to directing resources, planning public health initiatives, providing clinical care, and guiding future research.
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Affiliation(s)
- Philippa C Matthews
- Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford OX1 3SY, UK; Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
| | - Anna Maria Geretti
- Institute of Infection and Global Health, University of Liverpool, 8 West Derby Street, Liverpool L69 7BE, UK
| | - Philip J R Goulder
- Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford OX1 3SY, UK; Department of Paediatrics, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Paul Klenerman
- Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford OX1 3SY, UK; Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK; NIHR Biomedical Research Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
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22
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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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Tahaei SME, Mohebbi SR, Azimzadeh P, Behelgardi A, Sanati A, Mohammadi P, Khanyaghma M, Hosseini Razavi A, Sharifian A, Zali MR. Prevalence of hepatitis D virus in hepatitis B virus infected patients referred to Taleghani hospital, Tehran, Iran. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2014; 7:144-50. [PMID: 25120894 PMCID: PMC4129564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 05/18/2014] [Indexed: 10/27/2022]
Abstract
AIM The aim of this study was to determine the prevalence of HDV infection between HBV chronic patients referred to gastroenterology ward of Taleghani hospital Tehran, Iran and also investigating the risk factors in acquiring the HDV infection. BACKGROUND Hepatitis B virus (HBV) and Hepatitis D virus (HDV) are major public health issues. Worldwide there are approximately 350 million individuals chronically infected with the HBV. A significant part of them, including 15 to 20 million coinfected with HDV. Hepatitis Delta virus is transferred mostly through blood and body fluids. PATIENTS AND METHODS HBV and HDV infections were evaluated by Enzyme-linked immunosorbent assay (ELISA). Liver functional tests were assessed through auto analyzer. Patients were interviewed and data along the test results were entered into SPSS program. We used chi-square, independent t-test and logistic regression for statistical analysis. RESULTS 278 (54.6%) patients of the study group were male and 231 (45.4%) were female and the mean age of patients was 40.03 ± 14.93. From 509 patients, 39(7.7%) had anti-HDV antibody. In a uni-variable analysis, age (p=0.001), periodontal procedures (p=0.015), endoscopy (p=0.024) and colonoscopy (p=0.012) were significantly related to HDV seropositivity. After adjustment by logistic regression, age remained the only significant factor in acquiring HDV infection. CONCLUSION We highly recommend the health care workers to strictly follow the disinfection protocols of medical instruments. Since HDV seroprevalence changes over time, regular epidemiological studies are necessary to monitor the epidemiological trend of infection.
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Affiliation(s)
| | - Seyed Reza Mohebbi
- Gastroenterology and liver diseases Research center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Reprint or Correspondence: Seyed Reza Mohebbi, PhD.
Gastroenterology and liver diseases Research center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Pedram Azimzadeh
- Gastroenterology and liver diseases Research center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Behelgardi
- Gastroenterology and liver diseases Research center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azar Sanati
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvaneh Mohammadi
- Gastroenterology and liver diseases Research center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Khanyaghma
- Gastroenterology and liver diseases Research center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Hosseini Razavi
- Gastroenterology and liver diseases Research center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afsaneh Sharifian
- Gastroenterology and liver diseases Research center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zali
- Gastroenterology and liver diseases Research center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ducancelle A, Abgueguen P, Birguel J, Mansour W, Pivert A, Le Guillou-Guillemette H, Sobnangou JJ, Rameau A, Huraux JM, Lunel-Fabiani F. High endemicity and low molecular diversity of hepatitis B virus infections in pregnant women in a rural district of North Cameroon. PLoS One 2013; 8:e80346. [PMID: 24265811 PMCID: PMC3827216 DOI: 10.1371/journal.pone.0080346] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 10/01/2013] [Indexed: 02/07/2023] Open
Abstract
Background A program, supported by the GEMHEP (Groupe d'étude Moléculaire des Hépatites), was established in 2007 in the sanitary district of Tokombéré, to prevent perinatal transmission of hepatitis B virus (HBV). It comprises screening for HBV surface antigen (HBsAg) in all pregnant women and vaccinating the newborn if tests are positive. Methods/Principal Findings 1276 women were enrolled in the study after providing informed consent. Demographic data and blood samples were available for 1267 of the enrolled patients. HBsAg was determined locally using a rapid test (Vikia HBsAg, Biomerieux). Tests for HBV and HDV virological markers (HBeAg, anti-HDV antibodies (Ab), HBV-DNA, HDV-RNA, HBV and HDV genotypes) were performed on the confirmed HBsAg-positive samples in the virology unit of the Angers University Hospital (France). HBsAg was found in 259 of the 1267 pregnant women (20.4%) between January 2009 and April 2010, of whom 59 were HBeAg-positive (22.7%) with high levels of HBV-DNA. Anti-HDV Ab were found in 19 (7.3%) of the HBsAg-positive women. The prevalence rates of HBsAg and HDV were not age-dependent whereas HBeAg carriers were statistically younger than non carriers. Basal core promoter (BCP) and precore (PC) mutations and genotypes were determined by sequencing. Of 120 amplified sequences, 119 belonged to HBV genotype E (HBV/E) and the 9 HDV strains belonged to HDV clade 1. In the PC region, 83/228 patients (36.4%) harbored a G1896A mutant or mixed phenotype virus. In the BCP region, the double mutation A1762T/G1764A and the G1757A substitution were detected respectively in 26/228 patients (11.4%) and 189/228 patients (82.8%). Conclusions Our results confirm the high prevalence and low molecular diversity of HBV in Far Northern Cameroon; more than 20% of the infected women were highly viremic, suggesting a high rate of HBV perinatal transmission and supporting the WHO recommendation to vaccinate at birth against hepatitis B.
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Affiliation(s)
- Alexandra Ducancelle
- Department of Bacteriology and Virology, Angers University Hospital, and HIFIH Laboratory, UPRES 3859, SFR 4208, Angers Cedex 9, France
- * E-mail:
| | - Pierre Abgueguen
- Department of Infectious Diseases and Internal Medicine, Angers University Hospital, Angers Cedex 9, France
| | | | - Wael Mansour
- Department of Bacteriology and Virology, Angers University Hospital, and HIFIH Laboratory, UPRES 3859, SFR 4208, Angers Cedex 9, France
| | - Adeline Pivert
- Department of Bacteriology and Virology, Angers University Hospital, and HIFIH Laboratory, UPRES 3859, SFR 4208, Angers Cedex 9, France
| | - Hélène Le Guillou-Guillemette
- Department of Bacteriology and Virology, Angers University Hospital, and HIFIH Laboratory, UPRES 3859, SFR 4208, Angers Cedex 9, France
| | | | - Amélie Rameau
- Department of Bacteriology and Virology, Angers University Hospital, and HIFIH Laboratory, UPRES 3859, SFR 4208, Angers Cedex 9, France
| | - Jean-Marie Huraux
- Virology Laboratory, Hospital AP-HP Pitié-Salpêtrière, ER1 DETIV, University Paris VI Pierre et Marie Curie, France
| | - Françoise Lunel-Fabiani
- Department of Bacteriology and Virology, Angers University Hospital, and HIFIH Laboratory, UPRES 3859, SFR 4208, Angers Cedex 9, France
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Abstract
Hepatitis D is returning to western Europe through immigration. The clinical presentation recapitulates the typical features of a florid hepatitis D. Hepatitis D is also being rediscovered in the developing world and in the United States. Hepatitis D virus (HDV) remains endemic in many countries and efforts are underway to map the infection at local levels and improve the medical alert to hepatitis D. In the United States it is generally thought that HDV has gone and hepatitis D is no longer a problem. Awareness of hepatitis D in the country has recently been revived.
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Affiliation(s)
- Mario Rizzetto
- Division of Gastroenterology, University of Torino, Molinette, c.so Bramante 88, Torino 10126, Italy.
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26
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Impact of hepatitis B and delta virus co-infection on liver disease in Mauritania: a cross sectional study. J Infect 2013; 67:448-57. [PMID: 23796871 DOI: 10.1016/j.jinf.2013.06.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 05/22/2013] [Accepted: 06/05/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Mauritania is a highly endemic region for hepatitis B (HBV) and delta (HDV) viruses. No data are available on HDV's impact on the severity of liver disease in consecutive HBV-infected patients in Africa. This study evaluated the degree of liver fibrosis in a cohort of chronic HBV carriers. METHODS Three-hundred consecutive HBV-infected Mauritanian patients were checked for HDV infection via the detection of anti-HDV antibodies (Ab) and viral RNA. HBV- vs. HBV/HDV-infected patients were compared by physical examination, biological analyses, and the APRI (aspartate aminotransferase to platelet ratio index) and FibroMeter tests for determination of liver fibrosis. RESULTS More than 30% of the patients had anti-HDVAb. Among these, 62.2% were HDV-RNA positive. Co-infected patients were older (>8-years) than HBV-mono-infected patients. They had more liver tests abnormalities and clinical or ultrasound signs of liver fibrosis. APRI and FibroMeter scores were also significantly increased in these patients. In multivariate analysis, beyond HDVAb, male gender and HBV-VL >3.7 log IU/mL were the only markers linked to significant liver fibrosis. CONCLUSIONS In Mauritania, HDV co-infection worsens liver disease, both clinically and biologically, as confirmed by the APRI and FibroMeter tests. These tests may be useful for the management of delta hepatitis, which is a major health problem in Mauritania.
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Amini N, Alavian SM, Kabir A, Aalaei-Andabili SH, Saiedi Hosseini SY, Rizzetto M. Prevalence of hepatitis d in the eastern mediterranean region: systematic review and meta analysis. HEPATITIS MONTHLY 2013; 13:e8210. [PMID: 23554822 PMCID: PMC3609404 DOI: 10.5812/hepatmon.8210] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 09/01/2012] [Accepted: 09/22/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatitis D Virus (HDV) causes the most threatening form of chronic viral hepatitis. To date, there is no overall estimation of HDV prevalence in the Eastern Mediterranean Region Office of WHO (EMRO) countries. OBJECTIVES To provide a clear estimation of HDV prevalence in the aforementioned region. PATIENTS AND METHODS In the current systematic review, databases such as PubMed, Embase, Web of sciences and Google scholar were searched Until December 2010. The summary estimate of HDV prevalence in the EMRO region was calculated as an average of the pooled infection prevalence of each country weighted by the ratio of the country's HBV population to the study's sample size in the survey data analysis. RESULTS We included 62 eligible studies. The weighted mean of HDV prevalence in the EMRO region was 14.74% (95% CI: 14.73 - 14.77), 27.8% (95% CI: 27.78 - 27.82), 36.57% (95% CI: 36.55 - 36.59) and 16.44%. (95% CI: 16.42 - 16.46) in asymptomatic HBsAg positive carriers, chronic hepatitis patients, cirrhosis/ hepatocellular carcinoma, and high risk group, respectively. Among the asymptomatic HBsAg positive group, HDV prevalence was increased by years in older patients in Saudi Arabia but its prevalence was decreased in Iran. No specific pattern was seen according to chronological analysis during years among the EMRO countries. CONCLUSIONS HDV infection is endemic in the EMRO countries and it is more common among patients with severe forms of hepatitis. Due to the high HDV infection rates in the EMRO countries, we recommend blood screening for HDV infection in this region.
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Affiliation(s)
- Neda Amini
- Tehran University of Medical Sciences, Students' Scientific Research Centre, Tehran, IR Iran
| | - Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Seyed Moayed Alavian, Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel.: +98-2188067114, Fax: +98-2188067114, E-mail:
| | - Ali Kabir
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Center for Educational Research in Medical Sciences, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Seyed Hossein Aalaei-Andabili
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Seyed Yasser Saiedi Hosseini
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Mario Rizzetto
- Division of Gastroenterology, Molinette – University of Turin, Corso Bramante, Turin, Italy
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28
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Niro GA, Fontana R, Ippolito AM, Andriulli A. Epidemiology and diagnosis of hepatitis D virus. Future Virol 2012. [DOI: 10.2217/fvl.12.61] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The distribution of hepatitis D virus (HDV) is worldwide but not uniform. Current estimates suggest that 15–20 million people have exposure to HDV. Traditionally, areas of high prevalence are the Mediterranean basin, the Middle East, central Africa, the Amazonian basin and parts of Asia. As a consequence of vaccination against HBV and other prophylactic measures, the prevalence of HDV declined in Italy, Spain, Turkey and Taiwan. This downward trend stopped in the 1990s; a new location for HDV epidemics arose in western Europe, due to migration from endemic areas. HDV appeared in new geographic regions, posing a serious health threat in underdeveloped countries. Testing for anti-HVD antibodies in serum is the initial step in diagnosing HDV infection, but unravelling HDV RNA is essential to identify active replication.
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Affiliation(s)
- Grazia Anna Niro
- Division of Gastroenterology, ‘Casa Sollievo della Sofferenza’ Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - Rosanna Fontana
- Division of Gastroenterology, ‘Casa Sollievo della Sofferenza’ Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - Antonio Massimo Ippolito
- Division of Gastroenterology, ‘Casa Sollievo della Sofferenza’ Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - Angelo Andriulli
- Division of Gastroenterology, ‘Casa Sollievo della Sofferenza’ Hospital, IRCCS, San Giovanni Rotondo, Italy
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29
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Mansour W, Bollahi MA, Hamed CT, Brichler S, Le Gal F, Ducancelle A, Lô B, Gordien E, Rosenheim M, Lunel F. Virological and epidemiological features of hepatitis delta infection among blood donors in Nouakchott, Mauritania. J Clin Virol 2012; 55:12-6. [PMID: 22704272 DOI: 10.1016/j.jcv.2012.05.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 05/15/2012] [Accepted: 05/17/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND In Mauritania, some authors have described a possible high prevalence of hepatitis delta virus (HDV) infection in the 1990s in studies of small-size samples. OBJECTIVES The aims of our study were to assess the prevalence of HDV in HBsAg positive blood donors in Mauritania, to identify the main risk factors for HDV transmission and to analyze genetic diversity of HDV strains. STUDY DESIGN From October 2008 to December 2009, 11,100 consecutive blood donors were considered in this study. Among them, 1700 (15.3%) were HBsAg positive and 455 accepted to participate in this study. Demographic, epidemiological, ethnical, clinical and biological data were recorded. HDV screening, i.e., antibodies (HDVAb) and RNA (HDV-RNA) detection, was performed for all of them as well as HDV and HBV genotyping. RESULTS Ninety/455 (19.78%) donors were HDVAb positive and HDV-RNA was detectable in 56 (62.2%) of them. HDV infection was significantly associated with older age, number of marriages, military profession, residence in the desert and a history of hospitalization. The HDV genotypes of the circulating strains were HDV-1 (89.3%) and HDV-5 (10.7%). CONCLUSION HDV is highly endemic in Mauritanian blood donors indicating that a high number of them will develop chronic hepatitis, cirrhosis or hepatocellular carcinoma. Associated risk factors support nosocomial transmission of HDV. These data underline the need to reinforce HBV vaccination in newborns and in blood donors without HBV markers, together with screening for HDV in HBV-infected individuals.
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Affiliation(s)
- Wael Mansour
- Laboratoire de Virologie, CHU Angers, 4, rue Larrey, 49933 Angers Cedex 9, France
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Khan AU, Waqar M, Akram M, Zaib M, Wasim M, Ahmad S, Niaz Z, Ali S, Ali H, Idrees M, Bajwa MA. True prevalence of twin HDV-HBV infection in Pakistan: a molecular approach. Virol J 2011; 8:420. [PMID: 21888671 PMCID: PMC3179753 DOI: 10.1186/1743-422x-8-420] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 09/04/2011] [Indexed: 01/10/2023] Open
Abstract
Hepatitis Delta Virus (HDV) infects only patients that are already infected by hepatitis B virus (HBV) because this is sub satellite virus which depends on and propagate only in the presence of HBV. HDV causes co-infection or super infection with sever complication as compared to only HBV infection. No study on molecular level on HDV is available from this region; therefore, the aim of this study was to found out the molecular epidemiology of HDV (as a co-infection with HBV) in different geographical regions of Pakistan. Total 228 HBsAg positive samples were received for the study from different geographical regions of the country. Only HBV DNA PCR positive samples were further utilized for the presence of HDV RNA. For this purpose, HDV RNA and HBV DNA was extracted and amplified using reverse transcriptase polymerase chain reaction (RT-PCR), nested PCR and real-time PCR. Out of the total 228 HBsAg positive samples, HBV DNA was detected in total 190 (83.3%) samples belonged to different patients. Of these 190 patients, HDV RNA was observed in 53 (28%) patients. Of the 53 HDV positive cases, 37 (69.8%) were males and 16 (30.2%) were female patients. The percentage of dual infection was found higher significantly (p < 0.05) in male patients as compared to female patients. Total 41 (26.8%) patients were below 40 years and 13 (31.7%) were above 40 years of age. No significant difference was seen in patients with ages above or below 40 years. In the provinces of Sindh, Khyber Pakhtoonkhaw and Punjab the observed prevalence of HDV was 67%, 6% and 4% respectively. In conclusion, the HDV infection is not uncommon in Pakistan and its prevalence is higher significantly in the Province of Sindh (p < 0.01) and male six (p < 0.05).
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Affiliation(s)
- Asad U Khan
- Department of Microbiology, Hazara University Mansehra, Pakistan
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