Hepatitis B Virus (HBV)/Hepatitis D Virus (HDV) Coinfection in Outbreaks of Acute Hepatitis in the Peruvian Amazon Basin: The Roles of HDV Genotype III and HBV Genotype F

Abstract

Recurring outbreaks of acute hepatitis have been a significant cause of morbidity and mortality among Peruvian military personnel stationed in the Amazon Basin region of Peru. The role of hepatitis B virus (HBV) and hepatitis D virus (HDV) infection was investigated as the possible cause of acute hepatitis among 88 military patients stationed at four different jungle outposts during 1992-1993. Analysis of serum markers indicated that 95% (84/88) had evidence of acute HBV infection; 64% (54/84) were also infected with HDV. Genetic analysis of PCR-amplified HDV and HBV fragments showed exclusively HDV genotype III and HBV genotype F. Furthermore, HDV RNA sequences were similar among patients from the same outpost but different from those at other jungle locations. The data suggested focal sources of HDV infection in the jungle environment of the outposts and, further, confirmed the unique association of HDV genotype III with severe cases of human disease in northern South America.

Seroprevalence of viral hepatitis in riverine communities from the Western Region of the Brazilian Amazon Basin

“…Moreover, HDV infection in HBV carriers has been associated with an un- (Soares et al 1994, Casey et al 1996. The impact of HDV infection should be taken into consideration in the communities that were evaluated in this study, due to the very high prevalence found for this virus.…”

Hepatite D

“…Recentemente, novos estudos implicam o genótipo III do VHD associado ao subtipo F do VHB, como responsáveis por formas graves de hepatite que acometeram militares peruanos na bacia amazônica peruana 8 .…”

“…O HDV-RNA persistentemente positivo no soro no estágio agudo de infecção, indica a progressão para a cronicidade em 30 . Através de técnicas de análise genética de PCR-amplificado do genoma VHD, diretamente clonado e seqüenciado 7 , o diagnóstico laboratorial da infecção pelo vírus D, apesar da complexidade deste método e de não ser utilizado na rotina, tornou-se mais preciso, principalmente no que tange ao conhecimento da gravidade da infecção e de seu prognóstico 8 .…”

A polymerase chain reaction-based assay to identify genotype F of hepatitis B virus

“…Due to the importance of genotype F in the New World, a method capable of discriminating it should be useful for HBV molecular epidemiology studies in the Americas. Recently, it was shown that the presence of a SmaI restriction site could be used to recognize sequences from genotype F (19). Our method presents the advantage that is very simple and fast.…”