Changing hepatitis D virus epidemiology in a hepatitis B virus endemic area with a national vaccination program

Abstract

The emergence of hepatitis D virus (HDV) infection in the era of widespread HBV vaccination has not been described before. We aimed to investigate the changing epidemiology of HDV infection among high-and low-risk populations after an outbreak of human immunodeficiency virus (HIV) infection among injection drug users (IDUs) in Taiwan. A prospective, multicenter, cohort study of 2,562 hepatitis B surface antigen (HBsAg)-positive individuals was conducted to determine the prevalence, genotype, and risk factors of HDV infection from 2001 through 2012. The prevalence rates of HDV infection were 74.9%, 43.9%, 11.4%, 11.1%, and 4.4% among HIV-infected IDUs, HIV-uninfected IDUs, HIV-infected men who have sex with men, HIV-infected heterosexuals, and the general population of HBsAg-positive subjects, respectively. A significant increase in the trend of HDV prevalence from 38.5% to 89.8% was observed in HIV-infected IDUs (odds ratio 5 3.06; 95% confidence interval: 1.68-5.56; P 5 0.0002). In multivariate analysis, injection drug use, hepatitis C virus infection, HIV infection, serum HBsAg level м250 IU/mL, duration of drug use, and older age were significant factors associated with HDV infection. HDV genotype IV (72.2%) was the prevalent genotype circulating among IDUs, whereas genotype II was predominant in the non-IDU populations (73.3%). In the HIV cohort born after 1987 who were HBsAg negative, over half (52.9%) had antibody to hepatitis B surface antigen antibody levels of <10 mIU/mL and there was a significantly higher HBsAg seroprevalence in the HIV cohort, compared to the control group (8.1% vs. 0.0%; P 5 0.02). Conclusion: In the era of HBV vaccination, IDUs and HIV-infected individuals have emerged as high-risk groups and a reservoir for HDV infection. Effective strategies are needed to curb the reemerging epidemic of HDV infection in these high-risk groups. (HEPATOLOGY 2015;61:1870-1879 H epatitis D virus (HDV) is a defective, singlestranded RNA virus that requires hepatitis B surface antigen (HBsAg) envelope for assembly and transmission.1,2 Studies show that most patients with hepatitis B virus (HBV) and HDV dual infections have more severe liver disease, more rapid progression to cirrhosis, and increased frequency of hepatic decompensation and hepatocellular carcinoma

Prevalence and burden of hepatitis D virus infection in the global population: a systematic review and meta-analysis

“…We found that HBsAg-positive IVDU population has three times higher HDV seroprevalence than the population without any risk factors. The HDV seroprevalence rate was much higher in the HIV-infected IVDU than in HIV-uninfected IVDU,8 which indicates that the HIV coinfection might be a risk factor for HDV infection. High risk of HBV infection in IVDU could be related to the use and sharing of contaminated syringes 5.…”

“…By 2015, 97 nations have included the HBV birth dose vaccine, and 180 countries included the HepB3 vaccine (HepB3=three doses of hepatitis B vaccine) in their routine immunisation schedule 7. However, clustered outbreaks of HDV infection still occur8 and the treatment options of HDV infection remain limited. Relapse could still be observed after the use of interferon (IFN) α−2α9 or pegylated IFN α−2α 10.…”

Prevalence and genotype distribution of hepatitis delta virus among chronic hepatitis B carriers in Central Vietnam

“…HDV-2 to HDV-8 occur regionally [19]. For instance, HDV-2 prevails in countries like Japan [20], Taiwan [21, 22] and Russia [23]. HDV-3 which is a most diverged genotype is exclusively found in South America [18, 24, 25].…”

“…HDV-3 which is a most diverged genotype is exclusively found in South America [18, 24, 25]. HDV-4 is reported across Japan and Taiwan [21]; whereas HDV-5 to HDV-8 are described in Africa [26, 27]. …”

Exploratory study of hepatitis D virus infection in HBsAg carriers in Abidjan, Cte Divoire in 2016

“…But in a lot of countries such as Italy, this high frequency of HDV infection has declined where the prevalence has dropped from 22% in 1987 to 8.2% in 1997 (Gaeta et al, 2000). There are several factors such as improvement in socioeconomic status of the population, proper vaccination against HBV (Lin et al 2015) in Taiwan, better guidance and education regarding safety measures and systematic screening of the general population (Gaeta et al (2001). This is not the case of Côte d'Ivoire that is still in the exploratory phase concerning HDV.…”