Prevalence and clinical significance of hepatitis D virus co-infection in patients with chronic hepatitis B in Korea.

Hepatitis D virus (HDV) infection can cause severe acute and chronic liver disease in patients infected with hepatitis B virus (HBV). Despite the significant decline in the global HDV infection, it remains a major health concern in some countries. This study aimed to investigate the prevalence and clinical features of HDV co-infection in patients with chronic HBV infection in Korea, where HBV infection is endemic. Nine hundred forty patients [median age, 48 (18-94) years; men, 64.5%] infected chronically with HBV were enrolled consecutively. All patients who were positive for hepatitis B surface antigen (HBsAg) for at least 6 months and were tested for anti-HDV. A portion of the HDV delta antigen was amplified, sequenced, and subjected to molecular and phylogenetic analysis using sera from the patients who were anti-HDV positive. Clinical features and virologic markers were evaluated. Inactive HBsAg carriers, chronic hepatitis B, cirrhosis and hepatocellular carcinoma accounted for 29.5%, 44.7%, 17.9%, and 8.0%, respectively. Only three patients were positive for anti-HDV, corresponding to a 0.32% positive rate. All patients who were positive for anti-HDV were inactive HBsAg carriers. HDV RNA could be amplified by PCR from the sera of two patients. Phylogenetic analysis showed that both carried HDV genotype 1. In conclusion, the prevalence of HDV infection is very low (0.32%) in Korea. All HDVs were genotype 1 and detected in inactive HBsAg carriers. Therefore, HDV co-infection may not have a significant clinical impact in Korean patients with chronic HBV infection.

Kim HS ，Kim SJ ，Park HW ，Shin WG ，Kim KH ，Lee JH ，Kim HY ，Jang MK ... -  《-》

High prevalence of dual or triple infection of hepatitis B, C, and delta viruses among patients with chronic liver disease in Mongolia.

Mongolia is known for its high endemicity for hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis delta virus (HDV) infections among apparently healthy individuals. However, there are little or no data on the prevalence and genotype distribution of HBV, HCV, and HDV among patients with chronic liver disease in Mongolia. Therefore, serum samples obtained in 2004 from 207 patients (age, mean+/-standard deviation, 51.0+/-11.9 years) including those with chronic hepatitis (n=90), liver cirrhosis (n=41), and hepatocellular carcinoma (n=76) were tested for serological and molecular markers of HBV, HCV, and HDV infections. Of the 207 patients, 144 (69.6%), 106 (51.2%), and 117 (56.5%) tested positive for hepatitis B surface antigen (HBsAg) and/or HBV DNA, HCV RNA, and HDV RNA, respectively. Collectively, 172 patients (83.1%) were viremic for one or more of these viruses, including dual viremia of HBV/HDV (26.6%) or HBV/HCV (7.7%) and triple HBV/HCV/HDV viremia (30.0%). Of note, triple ongoing infection was significantly more frequent among patients with hepatocellular carcinoma than among those with chronic hepatitis (63.2% vs. 14.4%, P<0.0001). One hundred sixty patients (77.3%) had a history of blood transfusion and/or surgery. The distribution of HBV genotypes among the 116 HBV-viremic patients was: A (0.9%), B (0.9%), C (6.0%), D (88.8%), and C plus D (3.4%). All 117 HDV isolates were classified into genotype I. The 106 HCV RNA-positive samples were typed as genotype 1b (92.5%), 2a (0.9%), or 1b plus 2a (6.6%); mixed infection of two distinct HCV genotypes was found exclusively in the patients with hepatocellular carcinoma.

Tsatsralt-Od B ，Takahashi M ，Nishizawa T ，Endo K ，Inoue J ，Okamoto H ... -  《JOURNAL OF MEDICAL VIROLOGY》

Prevalence of hepatitis delta virus (HDV) infection in chronic hepatitis B patients in eastern Turkey: still a serious problem to consider.

Hepatitis delta virus (HDV) is a serious cause of liver-related morbidity and mortality. Coexistent infection with HDV tends to aggravate the course of hepatitis B virus (HBV)-associated liver disease. The aim of this study was to determine the prevalence of HDV infection among patients chronically infected with HBV in the Elazig region, which is in eastern Turkey. A group of 282 patients infected with chronic HBV were investigated for the study. Anti-HDV seropositivity was evaluated in all patients. The anti-HDV-positive patients were further tested for HDV RNA. Severity of liver disease was assessed by liver biopsy. Regression analysis was used to determine the relationship between independent variables and HDV positivity. Of 282 chronic HBV patients, 192 were men (68.1%) and 90 were women (31.9%). The mean age was 43.8 ± 12.7 (between 18 and 73 years). Anti-HDV was positive in 45.5% of the patients (128/282). Among the 128 anti-HDV-positive patients, 116 were checked for HDV RNA and 56.9% were found positive (66/116). Chronic HDV infection rate was therefore present in at least 23.4% of the whole study group (66/282). There were 83 patients with cirrhosis (29.4%) in the study group. Anti-HDV seroprevalence and HDV RNA presence were higher in those with cirrhosis (61.4% and 42.2%, respectively). No significant relationship was found between anti-HDV seropositivity and demographic factors such as age, sex and operation or transfusion history except family history. HDV-RNA-positive patients had significantly higher ALT and lower albumin levels when compared to HDV-RNA-negative patients. HDV-RNA-positive patients also had a significantly higher fibrosis stage. In conclusion, these findings demonstrated that HDV infection is endemic and still a serious problem in the Elazig region of eastern Turkey. HDV infection is significantly related to the family exposure and increases the risk of severe liver fibrosis in this region.

Bahcecioglu IH ，Aygun C ，Gozel N ，Poyrazoglu OK ，Bulut Y ，Yalniz M ... -  《-》

Seroprevalence of hepatitis D virus and its risk factors in the west of Iran.

Despite the decreasing trend in hepatitis D virus (HDV) infection worldwide, the importance of this disease cannot be underestimated. The aim of this study was to evaluate patients positive for HBsAg with respect to HDV infection and related factors. Patients with chronic hepatitis B who presented at Hamedan Province Hepatitis Community Center in 2002-2007 were included. A questionnaire covering demographic variables and history of hepatic disease was completed for each patient. Necessary tests were performed and antibodies to HDV were measured using an enzyme-linked immunosorbent assay. Of 81 HBsAg positive patients, 14 (17.3%) contained anti-HDV IgG. Only one of the patients with anti-HDV IgM was positive for HBsAg. Of the anti-HDV IgG positive patients, two (14.3%) were women. Among the women examined in this study, 24 (35.8%) were anti-HDV IgG negative (p = 0.21), and of these, six (42.8%) were HBeAg positive while 17 (25.4%) of the anti-HDV IgG negative women were positive for HBeAg (p = 0.16). The prevalence of chronic hepatitis B among anti-HDV IgG positive and negative patients was 28.6% and 39.2% respectively (p = 0.31). Because of the relatively high rate of hepatitis B virus (HBV) and HDV co-infection in our study subjects, it is vital that healthcare providers and policy makers to recognize the risk factors associated with this HBV and HDV co-infection as well as the reasons for this increased anti-HDV serology in HBV carriers.

Mohammad Alizadeh AH ，Ranjbar M ，Tehrani AS ，Keramat F ，Mamani M ，Rezazadeh M ，Aini P ，Khalilian A ，Majlesi A ，Hajilooi M ... -  《-》

Genotypes and phylogenetic characterization of hepatitis B and delta viruses in Egypt.

Hepatitis B virus (HBV) and hepatitis D virus (HDV) sequences among HBV carriers from Egypt have not been evaluated sufficiently. The genotypes of HBV isolated from 105 serum samples from Egyptian carriers were determined. Four complete genomes and 11 entire preS1/S2/S genes were sequenced and evaluated. All serum samples were classified into HBV genotype D using serologic and genetic methods. The length of four complete nucleotide sequences was 3,182 bp. In all 15 samples, the common 33 nucleotides (11 amino acids) deletions in the preS1 region specific for HBV genotype D were observed. In the phylogenetic analysis based on the complete nucleotide sequences, all samples were clustered with the HBV isolates reported from previously Western and Mediterranean countries with nucleotide homology ranging from 96.0-98.0%. Of 75 HBsAg positive samples, anti-HDV was found in 15 (20%), and HDV RNA was detected in 9 of 15 (60%). The proportion of the patients with liver disease was higher in HBV carriers of anti-HDV positive with HDV RNA than in HBV carriers of anti-HDV positive without HDV RNA (P < 0.05). In the phylogenetic analysis based on the sequences in nucleotide position 853-1267 of HDV, nine samples were classified into HDV genotype I with the nucleotide homology ranging from 88.3-92.1% (mean; 90.5%) and clustered with HDV strains reported previously from Ethiopia, Somalia, Egypt, and Lebanon. These results indicate that HBV genotype D and HDV genotype I are most prevalent in Egypt, and HDV co-infection in HBV carriers is related to severity of liver disease.

Saudy N ，Sugauchi F ，Tanaka Y ，Suzuki S ，Aal AA ，Zaid MA ，Agha S ，Mizokami M ... -  《JOURNAL OF MEDICAL VIROLOGY》