Elimination of HDV: Epidemiologic implications and public health perspectives

Abstract

Hepatitis delta virus (HDV) infection causes the severest form of viral hepatitis in humans. Discovered in 1977, it was considered an infection prevalent in the eastern Mediterranean region. Today it is recognized as a global infection of public health importance, however accurate prevalence remains uncertain because of lack of good epidemiological studies. Under‐screening for HDV is the single most important factor in under‐estimating the true burden of infection. Urgent efforts are therefore needed to apply reliable screening tools and robust surveillance methodologies to study HDV. There is now a move by major hepatology societies to recommend HDV antibody testing in all persons with HBV infection. Important differences also need to be recognized between countries considered endemic or non‐endemic countries. While the endemic infections likely spread horizontally in the general population, and is quite often nosocomial, in non‐endemic countries special populations may carry the greater burden, such as persons with injection drug use and various sexual exposures. Even in endemic countries, HDV often exists in significant pockets of the general population. HDV has been categorized as an orphan infection due to lack of approved therapies. Recently there have significant advances in therapy and further clinical trials continue. However, as new therapies are approved, equitable access to the medications will become a major public health issue, particularly because most HDV patients live in low or low middle income countries.

No Hepatitis Delta Virus Seropositivity among Blood Donors with Overt and Occult Hepatitis B Infection in Dalian, Liaoning Province, China

“…NAT NDR samples (327/368; 88.9%) were also included, as it has previously been shown that HBV DNA carriage can be confirmed by extended testing in around 66% of cases [ 17 ]. In addition, underscreening for HDV markers in HBV carriers with no detectable HBsAg may lead to a significant underestimation of the global HDV prevalence [ 27 ].…”

Hepatitis Delta: Ready for primetime?

“…In their dedicated review article of this special issue, Tharwani and Hamid discuss the requirements on a global scale and nicely describe more specific needs depending on the HDV prevalence and affected population. 44 Another important task will be the further improvement of HDV therapy. As discussed before, there remain several unanswered questions regarding the current treatment option with bulevirtide ± Peg-IFN.…”