Hepatitis D virus infection in a large cohort of immigrants in southern Italy: a multicenter, prospective study

Abstract

Background Since few data are available in the literature on the prevalence of anti-Delta-positive subjects in immigrant populations, the aim of the present study was to evaluate the demographic and virological characteristics of HDV infection in a large cohort of immigrants living in southern Italy. Methods Between January 2012 and February 2020 all immigrants attending one of the 5 first- level centers were enrolled and screened for HBsAg, the HBsAg-positive for anti-Delta and if positive, for HDV-RNA and HDV genotype. Results Of the 3521 immigrants observed in the study period, 3417 (97.0%) agreed to be screened; they were mainly males (61%), with a median age of 27 years (IQR 8–74) and came prevalently (58%) from sub-Saharan Africa. Of the 3417 patients enrolled, 319 (9%) subjects were HBsAg-positive, and of those, 8 (2.5%) were anti-Delta-positive. No difference in the demographic and epidemiological characteristics was observed between the anti-Delta-negative vs -positive. Of the 8 anti-Delta-positive subjects, only one was HDV-RNA-positive (viral load: 7050 IU/mL), genotype 1, with clinical signs of cirrhosis. Conclusions the present study showed a prevalence of HDV of 2.5% in a large cohort of asymptomatic immigrants, suggesting the need for screening campaigns for viral infections including delta hepatitis in this population.

Characterization of hepatitis virus co‐infections in a cohort of immigrants living in southern Italy

“…[27][28][29][30][31][32] As regards HDV infection, in the world it is estimated that there are around 12-60 million HBV/HDV co-infected subjects 5,[33][34][35][36][37] ; therefore, the HDV seroprevalence among HBV carriers varies widely in different geographical areas. 5,17,[34][35][36][37] Considering the virological and clinical aspects, HBV-HDV co-infection is characterized by a more frequent replication of HDV infection and a severe prognosis with a more frequent development of cirrhosis and HCC compared with the HBV mono-infected. 36,38 However, the data on the virological and clinical aspects of HCV mono-infection.…”

“…Despite this reciprocal viral inhibition, chronic HBV/HCV co‐infection is a serious virological condition associated with more severe forms of liver disease 27–32 . As regards HDV infection, in the world it is estimated that there are around 12‐60 million HBV/HDV co‐infected subjects 5,33–37 ; therefore, the HDV seroprevalence among HBV carriers varies widely in different geographical areas 5,17,34–37 . Considering the virological and clinical aspects, HBV‐HDV co‐infection is characterized by a more frequent replication of HDV infection and a severe prognosis with a more frequent development of cirrhosis and HCC compared with the HBV mono‐infected 36,38 …”

“…LLoQ for the HDV‐RNA test was 45 copies/mL. HDV genotype was determined in HDV‐RNA‐positive samples, as previously described 17 …”

“…All undocumented immigrants and low-income refugees consecutively evaluated for clinical consultation at one of the five first-level centers participating in the study from January 2012 to February 2020 were enrolled. [13][14][15][16][17] The study was temporarily stopped due to the COVID-19 pandemic.…”

“…HDV genotype was determined in HDV-RNA-positive samples, as previously described. 17 Serum HCV-RNA was quantified by a real-time PCR method in a Light cycler 1.5 (Roche Diagnostics) with a sensitivity of less than 40 IU/mL, as previously reported. 20,21 HCV genotypes were identified by the HCV genotype Lipa assay (Bayer).…”