High Prevalence of Chronic Viral Hepatitis and Liver Fibrosis Among Mongols in Southern California

Abstract

Background: Mongolia is a highly endemic region for chronic hepatitis B (HBV), hepatitis delta (HDV), and hepatitis C (HCV) infections. Aim of this study was to comprehensively characterize chronic viral hepatitis among Mongols living in Southern California. Methods: Three screening events were conducted between August to November 2018, with 528 adult Mongols tested for HBV and HCV. HBsAg (+) individuals (CHB) underwent additional testing for HDV RNA and anti-HDV. Liver tests, platelet count and FibroScan™ were performed on CHB and chronic HCV (CHC) individuals. Results: 51/534 were HBsAg reactive (9.7%) and all were foreign born. Mean age of CHB individuals was 37.8 (range 18–69) years. 46/51 were HBeAg (−). HBV genotypes were exclusively D2 or A1. 21/51 (41.2%) were anti-HDV (+) and 17/51 (33.3%) were HDV-RNA (+). HDV RNA (+) individuals had significantly higher ALT, Fibrosis-4 score and liver stiffness compared to HDV RNA (−) individuals. Incidence of advanced fibrosis was higher in HDV RNA (+) individuals (57% vs. 13%, p=0.013). 48 (9.1%) individuals were anti-HCV (+) and 19 (3.6%) were HCV RNA (+). Mean age of CHC individuals was 40.2 (range 28–71) years. Prevalence of anti-HCV (+) was higher among those born between 1945–1965 versus those born after 1965 (18.8% vs 7.9%, p=0.025). Genotype 1b was predominant. Incidence of cirrhosis was 7% among all participants. Conclusions: Mongols living in the US are at high risk for CHB and CHC infections. One-third of CHB individuals had CHD super-infection with advanced fibrosis. Universal screening for viral hepatitis in Mongols in the U.S. is mandatory.

Low Performance of Hepatitis Delta Virus Testing Among 2 National Cohorts of Chronic Hepatitis B Patients in the United States

“…Our findings are similar to existing studies in smaller US cohorts reporting low rates of HDV testing among CHB patients (4,10–12). Gish et al (12) retrospectively evaluated 1191 CHB patients at a single center from 2002 to 2007 and observed that 499 patients underwent HDV testing, among whom 42 (8%) were found to be HDV-positive.…”

The changing context of hepatitis D

“…36 As in Europe, the infection predominates in IVDUs and foreign-born individuals. [37][38][39][40] Although the scarcity of HBsAg carriers in the US may affect perceptions on the impact of CHD, the recent NHANES findings would support screening all HBsAg carriers.…”

Enhanced Screening for Hepatitis D in the USA: Overcoming the Delta Blues

“…The "at risk" groups include persons who inject illicit drugs, persons with HIV, men who have sex with men, those at risk for sexually transmitted diseases, and persons who emigrated from countries of high endemicity [8]. The importance of country of origin as a risk factor for HDV in the USA is underscored by the study from Fong and colleagues from the University of Southern California published in this issue of Digestive Diseases and Sciences [9]. Among 534 Mongol immigrants and their families who participated in three community screening events conducted in 2018, 9.7% were HBsAg positive, and among these individuals, 41% were anti-HDV positive, one-third of whom were HDV RNA positive.…”