Virological and clinical characteristics of delta hepatitis in Central Europe

Abstract

Hepatitis D virus (HDV) or delta hepatitis has mainly been studied in Asian and Mediterranean cohorts, but data on virological and clinical characteristics of HDV-infected Central and Northern European patients are limited. We investigated virological patterns, as well as biochemical and clinical features of liver disease in 258 HDV infected patients recruited over a period of 15 years at Hannover Medical School. Virological parameters were compared to 2083 anti-HDV negative hepatitis B surface antigen (HBsAg) positive individuals. In this cohort, (i) HDV infection was associated with both suppressed hepatitis B virus (HBV) and hepatitis C virus (HCV) replication, (ii) the suppression of HBV-DNA and HCV-RNA was not related to HDV-RNA replication, (iii) mean HBsAg levels did not significantly differ between HBV-monoinfected patients and individuals with delta hepatitis, (iv) HCV coinfection was rather frequent as about one third of our delta hepatitis patients tested anti-HCV positive, however, without being associated with more advanced liver disease, (v) delta hepatitis patients presented in a high frequency with an advanced stage of liver disease, and (vi) the course of delta hepatitis did not differ between Turkish-born, Eastern European (EE)-born and German-born patients. In summary, in this cohort of patients which is the largest so far Central European single centre group of delta hepatitis patients, we confirm the presence of frequently severe disease and describe novel virological profiles which require consideration in the management of this difficult to treat group of patients.

Replicative and Transcriptional Activities of Hepatitis B Virus in Patients Coinfected with Hepatitis B and Hepatitis Delta Viruses

“…In this study, we applied sensitive molecular assays to evaluate serologic and intrahepatic quantitative profiles of HBV and HDV in chronic infections. In accordance with previous studies (9,10,23,40), our results seem to confirm that HDV exerts a dominant role over HBV, as indicated by its higher levels of replication and by the lower levels of serum and intrahepatic HBV DNA, cccDNA, and HBV transcripts detected in the majority of coinfected patients than those in HBV-monoinfected individuals. However, in agreement with previously reported data, we found that serum HBsAg levels were comparable between HDV-positive and HDV-negative patients (8) and that amounts of pre-S/S RNAs and HBsAg produced per cccDNA molecule were higher in HDV-positive patients.…”

“…Finally, HBV genomes with large deletions in the basal core promoter/precore region were detected in 5/21 HDV-positive patients but in no HDV-negative patients and were associated with lower viremia levels. These findings provide significant information about the interference exerted by HDV on HBV replication and transcription activities in the human liver.Hepatitis delta virus (HDV) is a worldwide diffuse pathogen commonly associated with severe forms of liver disease (9,21,22,35). HDV can establish infection only in individuals with continuing hepatitis B virus (HBV) infection, since it requires obligatory helper functions provided by HBV for in vivo infection.…”

“…Hepatitis delta virus (HDV) is a worldwide diffuse pathogen commonly associated with severe forms of liver disease (9,21,22,35). HDV can establish infection only in individuals with continuing hepatitis B virus (HBV) infection, since it requires obligatory helper functions provided by HBV for in vivo infection.…”

Performance Characteristics of a New Consensus Commercial Kit for Hepatitis D Virus RNA Viral Load Quantification

“…Particularly, African HDV genotypes (i.e., HDV-1 and HDV-5 to -8) are poorly quantified by almost all available assays and are either undetected or dramatically underestimated (11). These different genotypes originally had a specific geographic distribution; however, due to ancient or recent migrations of populations, this genetic variability is now encountered in different countries worldwide (9)(10)(11)(17)(18)(19)(20)(21)(22)(23)(24)(25). In this respect, France, where genotypes HDV-5 to -8 representing 20% of spreading strains were characterized, is an outstanding example (26,27).…”

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

“…HDV RNA was found in 61% of the HDV-Ab patients, indicating the low prevalence of HDV clearance in this population. The natural history of HDV infection shows that coinfection evolves to chronicity in only a small number of patients and patients recover from both hepatitis B and hepatitis D, while superinfection of HDV leads to progressive disease and cirrhosis in approximately 60 to 80% of cases (1,2). It can thus be suggested that most of our patients acquired the infection as a superinfection on hepatitis B.…”