The medical impact of hepatitis D virus infection in Asia and Africa; time for a reappraisal

Abstract

Although hepatitis D is believed to be an important medical problem in Africa and many areas of Asia, the geographical distribution and prevalence rates of infection with the hepatitis D virus (HDV) vary considerably, are often inconsistent and sometimes conflicting. Discrepancies may depend on methodological problems, primarily on different modalities of patients' recruitment; these are analysed in this mini-review, in order to provide a uniform clinical approach when testing patients with chronic HDV disease. K E Y W O R D S hepatitis D, hepatitis D virus, hepatitis delta How to cite this article: Rizzetto M, Hamid S. The medical impact of hepatitis D virus infection in Asia and Africa; time for a reappraisal.

The changing context of hepatitis D

“…112 It follows that the rate of anti-HD increases in parallel with the severity of liver disease the probability of finding the antibody throughout the clinical spectrum of HBV infections is lowest in asymptomatic/minor forms and highest in patients with serious disease. This is confirmed by the 5-to 10-fold difference in the prevalence of anti-HD between asymptomatic blood donors and patients with cirrhosis, 113 as seen in Italy, 114,115 Turkey 116 and Uzbekistan. 113 Blood donors are largely non-viraemic: serum HDV RNA was detected in 22.9% of 61 donors in a French study from 1997 to 2011 117 and in only 2 of 13 donors in a study from Turkey in 2014.…”

“…This is confirmed by the 5-to 10-fold difference in the prevalence of anti-HD between asymptomatic blood donors and patients with cirrhosis, 113 as seen in Italy, 114,115 Turkey 116 and Uzbekistan. 113 Blood donors are largely non-viraemic: serum HDV RNA was detected in 22.9% of 61 donors in a French study from 1997 to 2011 117 and in only 2 of 13 donors in a study from Turkey in 2014. 116 The corollary is that the interpretation of the clinical meaning of anti-HD must consider the type of population recruited for testing.…”

“…Thus, the appraisal of the medical burden of HDV in a given country should preferentially be based on surveys for anti-HD among HBsAg-positive patients with cirrhosis. 113…”

Molecular epidemiology and clinical characteristics of hepatitis D virus infection in Canada

“…Chronic infection with hepatitis D virus (HDV) results in the highest rate of severe liver disease, including the development of cirrhosis in nearly 80% of patients within 2 to 10 years of infection 1,2 , with a significantly increased risk of hepatocellular carcinoma (HCC) compared to hepatitis B virus (HBV) infection alone 3 . HDV requires HBV to complete its replication cycle and produce enveloped viral particles providing receptor-binding function.…”

Bulevirtide for treatment of patients with HDV infection and compensated cirrhosis: A (huge?) step in the right direction

“…The prevalence of HDV infection, 2 among HBsAg‐positive patients is 4.5%, resulting in roughly 12 million people coinfected globally. Wide geographical variations are observed, with highest prevalence rates reported in Mongolia, Pakistan, Moldova, Western and Middle African countries 3 …”