High Prevalence and Predominance of Hepatitis Delta Virus Genotype 1 Infection in Cameroon

Abstract

Antibodies to the hepatitis delta virus (HDV) were found in 17.6% of 233 hepatitis B virus surface antigenpositive subjects in Cameroon. Phylogenetic analyses showed the presence of HDV-1, HDV-5, HDV-6, and HDV-7 genotypes. These results enrich the limited data on HDV prevalence and molecular diversity in Cameroon.Hepatitis delta virus (HDV) is associated with hepatitis B virus (HBV) infection and is frequently related to more severe disease than that due to the underlying HBV monoinfection (5, 10). HDV infection has a worldwide distribution, but its frequency varies greatly throughout different geographic regions. It is highly endemic in the Middle East, in the Mediterranean area, in the Amazonian region, and in several African countries (3). Genomic analysis of HDV isolates from different regions of the world reported at least eight phylogenetically distinct genotypes with dissimilar geographic distributions. Apart from HDV genotype 1 (HDV-1), which is ubiquitous, each virus clade is geographically localized: HDV-2 is found in Japan, Taiwan, and Russia; HDV-4 is found in Taiwan and Japan; HDV-3 is found in the Amazonian region; and HDV-5, HDV-6, HDV-7, and HDV-8 are found in Africa (6). The role of these HDV genotypes is not yet well determined, but some studies have suggested an association between the severity of disease and infection with different HDV genotypes (4, 8). The two studies conducted 2 decades ago on HDV infection in Cameroon have reported the prevalence of antibodies against HDV (HDV-Ab) of 6.5% and 27.3%, respectively (9, 12). In spite of this high prevalence, no data on HDV genotype diversity in Cameroon are available. Therefore, in the present study, we investigated the current HDV seroprevalence and the genotype diversity in Cameroonian patients with chronic HBV infection.This study was performed on plasma samples from 233 hepatitis B virus surface antigen (HBsAg) carriers (mean age, 34.5 years; 79 women and 154 men) seen at two medical care centers in Yaounde, Cameroon, from May 2008 to May 2009. As recommended by the Cameroonian Society of Gastroenterology, in addition to the HBV DNA quantification and the assessment of biochemical liver enzyme, HDV screening should be part of the screening of HBsAg carriers, considering the endemicity of this infection in Central Africa. The analyses included in HDV screening are HDV antibody (HDV-Ab) and HDV RNA quantification for HDV-Ab-positive patients. During the medical consultation, HBsAg carriers were screened for HDV infection and were asked to participate in this study. For carriers who agreed to participate, written informed consent was obtained for HDV genotyping, since this analysis is not part of the original protocol in a routine workup of liver disease.The presence of HDV-Ab was determined by the Murex anti-delta assay (Abbott, Wiesbaden, Germany), and HBV DNA viral load was determined by the Abbott RealTime HBV quantification kit (Abbott Molecular Inc., Rungis, France) according to the manufacturer's protocol. During routine workup of th...

Characterization of Hepatitis Delta Virus in Sub-Saharan Africa

“…The rare HDV seroprevalence studies that have been performed during the past 15 years and the recent reports of the African clades 5 to 8 (5,6) als), Gabon (15.6% to 70.6%), Mauritania (14.7% to 33.1%), Mozambique (0%), Nigeria (0% to 12.5%), and Senegal (3.2%), revealed various HDV antibody rates (2,(15)(16)(17)(18)(19)(36)(37)(38)(39)(40). Interestingly, also in our study, the HDV Ab prevalences varied widely and ranged from 0% to 27.3% in asymptomatic carriers and from 1.3% to 50% in liver patients.…”

“…Of these, 15 were attributed to these supposedly "African" clades, while 10 strains clustered with clade 1 (5,6). Despite their characterization as African clades, only few genotyping studies have been performed in Africa (Cameroon, clades 1, 5, 6, 7; Gabon, clades 1, 7, and 8; Mauritania, clades 1 and 5), and clade 1 dominated in all cohorts (2,5,6,(15)(16)(17)(18)(19).…”

“…Coinfection with these two viruses results in fulminant hepatitis more often than with HBV infection alone, and superinfection of HBV with HDV is associated with chronic HDV in up to 80% of carriers (1). Both HBV and HDV occur worldwide and are genetically highly diverse (2)(3)(4)(5)(6)(7). While HBV is classified into nine genotypes, A to I (8), as well as a recently proposed genotype J (9), HDV strains have been separated into eight distinct clades 1 to 8 (5,6).…”

Hepatitis D Virus: Introduction and Epidemiology

“…In 2009, an antibody rate of 66.7% was reported in Gabon (Makuwa et al 2009). In Cameroon (Foupouapouognigni et al 2011), anti-HD was found in 17.6% of 233 patients with CHB at two medical centers. In Nigeria, anti-HD was found in 12.5% of 96 patients with HBsAg liver disease (Nwokediuko and Ijeoma 2009), and in Mauritania, in 14.7% of HBsAg-positive pregnant women (Mansour et al 2012).…”

Application of PCR Technologies to Humans, Animals, Plants and Pathogens from Central Africa

“…Interestingly, these results showed that HCV infection may lead to slower emergence of P. falciparum in blood [137]. Other studies have demonstrated the usefulness of the PCR as a tool for the description of the molecular diversity of other less known/marginal viruses in this region, such as hepatitis delta virus in Cameroon [139] and in Gabon [140], or hepatitis GB-C/HG virus and TT virus in Gabon [141].…”