Hepatitis D: challenges in the estimation of true prevalence and laboratory diagnosis

Abstract

Hepatitis delta virus (HDV) is a defective single negative chain RNA virus, as its envelope protein synthesis is dependent on hepatitis B virus (HBV). Studies have consistently shown that coinfection of HBV and HDV is the most serious form of viral hepatitis, with accelerated progression to liver cirrhosis and hepatocellular carcinoma. About 74 million of HBV surface antigen (HBsAg) positive patients worldwide are also co-infected with HDV. Besides, patients with intravenous drug use and high-risk sexual behavior are at higher risk of HDV infection. Therapeutic schedules for HDV are limited, and relapse of HDV has been observed after treatment with pegylated interferon alpha. To reduce the transmission of HDV, all people infected with HBV should be screened for HDV. At present, several serological and molecular detection methods are widely used in the diagnosis of HDV. However, due to the lack of international standards diagnostic results from different laboratories are often not comparable. Therefore, the true prevalence of HDV is still unclear. In this manuscript, we have analyzed various factors influencing the estimation of HDV prevalence. We have also discussed about the advantages and disadvantages of currently available HDV laboratory diagnostic methods, in order to provide some ideas for improving the detection of HDV.

Low seroprevalence of hepatitis delta virus co-infection in hepatitis B virus-infected blood donors in China: A multicenter study

“…Antibody testing is often used as the primary screening test for HDV infections ( Chen et al, 2021 ). IgM antibodies against HDAg are detectable approximately 4 weeks after exposure, and decrease and gradually disappear at 2 months after acute infection, or can be elevated in patients with chronic HDV during disease progression.…”

Identifying and Screening At-Risk Patients for Hepatitis Delta Virus: A Case Report

“…Individuals at higher risk include those who have migrated from Eastern and Southern Europe, the Middle East, Western and Central Africa, and East Asia, where HDV is endemic. Other risk factors include immunosuppressed patients, hemodialysis patients, gay and bisexual men, persons who inject drugs, and persons employed in healthcare or public safety professions [ 8 , 9 ]. Testing should be performed by obtaining total HDV antibodies with confirmation of the diagnosis by serum reverse transcriptase-polymerase chain reaction.…”

Determinants of Hepatitis D in Sub-Saharan Africa: Trends and Challenges (Systematic Review)

“…This is in agreement with a recent hepatitis delta outbreak reported in ongoing epidemics of injection drug use in Eastern Europe and Russia. Interestingly, new incident cases of HDV in Taiwan are no longer among intravenous drug users but among HIV-positive homosexual men, often presenting with liver flare-ups and syphilis independently of the use of successful antiretroviral therapy (Chen et al, 2021).…”