Clinical presentation of hepatitis D in Pakistani children

Abbas, Zaigham; Soomro, Ghous Bux; Hassan, Syed Mujahid; Luck, Nasir Hassan

doi:10.1097/meg.0000000000000168

Cited by 11 publications

(4 citation statements)

References 18 publications

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“…We previously reported that children with HDV infection have a more aggressive form of liver disease than those with HBV monoinfection [10]. This was observed irrespective of HBeAg status.…”

Section: Discussionmentioning

confidence: 81%

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The Severity of Hepatitis D in Young Adults of Age 18-25 Years

Abbas

Qadeer

Mandviwalla

et al. 2020

Cureus

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Background Current literature on the prevalence and characteristics of hepatitis D virus (HDV) infection in young adults is limited. This study aims to determine the disease characteristics and severity in young adults. Methods The case records of HDV RNA positive patients of age 18-25 years were analyzed. Results Out of 119 patients, 105 (88%) patients were male. HBV-DNA was detectable in 83 (70%). Hepatitis B eantigen (HBeAg) was non-reactive in 99 (83%). Cirrhosis was identified in 45 (37.8%) individuals; nine (7.5%) were classified as Child class B or Child class C. Twenty-four (20.2%) had a Model For End-Stage Liver Disease (MELD) score of ≥10, out of these 16 had a score of 15 or more. The risk of decompensation was calculated according to the Baseline-event-anticipation (BEA) score; eight (6.7%) patients were at BEA-A (mild risk), 105 (88.2%) were at BEA-B (moderate risk), and six (5.0%) were at BEA-C (severe risk). Notable findings in patients with cirrhosis included splenomegaly, low total leucocyte counts, low platelets, high bilirubin, elevated aspartate aminotransferase, gamma-glutamyl transferase and international normalization ratio, low albumin, high AST to Platelet Ratio Index (APRI), and high BEA score. The splenic size, platelet count, and albumin levels were independently associated with cirrhosis (p < 0.001, <0.001, and 0.003). A model using a combination of platelet count, albumin, and spleen size was developed to accurately predict cirrhosis in this cohort. It had an area under the receiver operating characteristics (AUROC) of 0.935. Conclusions HDV-infected young adults, age 18-25 years, were at moderate to severe risk of disease progression. About one-third of patients had already developed cirrhosis indicating the aggressive nature of the disease.

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Section: Discussionmentioning

confidence: 81%

“…Cirrhosis was seen in 13 (27%) cases with hepatitis D compared with two (4%) with hepatitis B monoinfection. Six patients with hepatitis D had decompensation at the time of presentation, whereas only one patient with HBV monoinfection had decompensation [10].…”

Section: Introductionmentioning

confidence: 97%

The Severity of Hepatitis D in Young Adults of Age 18-25 Years

Abbas

Qadeer

Mandviwalla

et al. 2020

Cureus

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“…Despite this, alanine aminotransferase (ALT) was elevated in almost all patients and there was no difference in the severity of disease in HBeAg-reactive and HBeAg-nonreactive HDV patients. Indeed, of the six patients with decompensation, five were HBV DNA positive [ 58 ]. Moreover, HDV-infected children in this study progressed to significantly worse outcomes than those with HBV mono-infection alone (matched controls).…”

Section: Reviewmentioning

confidence: 99%

An Insight Into the Factors Affecting the Prevalence and Natural History of Hepatitis D

Abbas,

Abbas

2023

Cureus

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Epidemiological studies and recent metanalyses addressing hepatitis D have reported a wide variation in the prevalence of the disease. Between 4.5% to 15% of all hepatitis B surface antigen (HBsAg) positive patients are thought to harbor the hepatitis D virus. The emergent variation in prevalence can be attributed to several factors. Unsurprisingly, published literature shows that the prevalence of the disease is higher in areas where aggregate viral hepatitis infections are endemic and amongst groups with high-risk practices facilitating the horizontal transfer. Meanwhile, the natural history of the disease is influenced by the genotype of the virus, the hepatitis D virus (HDV) RNA levels, HBV-HDV codominance, HBsAg titers, HBV genotype, nutritional status, HIV co-infection, and prior treatment. Together these factors contribute to the accelerated development of fibrosis and the increased risk of hepatocellular carcinoma. Superinfection with genotype 1 results in rapid progression to cirrhosis with lower rates of remission. Genotype 3 follows an aggressive course but shows a good response to interferon therapy. Other genotypes have better outcomes. The course of the disease leading to these outcomes can be tracked by HDV-specific models integrating clinical surrogate markers and epidemiological factors such as age, region, alanine aminotransferase (ALT), gamma-glutamyl transferase, albumin, platelets and cholinesterase, and liver stiffness.

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“…In Mauritania, HDV co-infection worsens liver disease, both clinically and biologically, as confirmed by the APRI and FibroMeter tests. These tests may be useful for the management of delta hepatitis, which is a major health problem in Mauritania (40).…”

Section: Mauritaniamentioning

confidence: 99%

Chronic delta hepatitis: from discovery to new treatments

Turcanu

Wani

2021

OH&RM

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Introduction. Hepatitis delta virus (HDV) is a small, defective RNA virus that is related more to plant viroids than to other human pathogens. Material and methods. Nearly 50 research articles from various sources were reviewed and a comprehensive analysis was done regarding various parameters concerning HDV. Articles published over a period of 30 years were selected based on their experimental and statistical relevance to HDV. This review gives a brief insight into epidemiology, genetics, clinical evolution and treatment of chronic hepatitis delta. Results. Chronic hepatitis delta remains a major cause of morbidity in Eastern European countries and the Mediterranean region. At the same time, there is a resurgence of HBV and HDV infection in young people (under the age of 50) in Western Europe, as a consequence of the intra-familial and sexual mode of acquisition among immigrants from Eastern Europe, the Mediterranean region and from countries of the former Soviet Union, Africa high burdened regions of Asia and South America. Prevalence among IVDU was found to be higher especially in western european countries and other regions of low HDV prevalence. Chronic delta viral hepatitis is a dynamic, progressive process. A direct cytopathic pattern of liver tissue damage was also observed, especially in the presence of HDV genotype 3. Chronic hepatitis D is reported to progress to cirrhosis and hepatocellular cancer, and this trend is greater the higher the level of HDV viremia at the time of presentation. Conclusions. Flaws in screening and on-time diagnosis still remain due to the insufficient research and data available. While still not classified as a carcinogen by IARC, our review ends up in support of the notion that HDV infection increases the chances and fastens the pathogenic processes leading to HCC.

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Clinical presentation of hepatitis D in Pakistani children

Abstract: Children with HDV infection have more aggressive liver disease than HBV monoinfection irrespective of HBeAg status.

Cited by 11 publications

References 18 publications

The Severity of Hepatitis D in Young Adults of Age 18-25 Years

The Severity of Hepatitis D in Young Adults of Age 18-25 Years

An Insight Into the Factors Affecting the Prevalence and Natural History of Hepatitis D

Chronic delta hepatitis: from discovery to new treatments

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