Hepatitis D virus in Bulgaria: virology, epidemiology and pathogenesis in chronic HBV carriers with liver dysfunction

Abstract

INRODUCTION: Hepatitis D (HDV) is the most interesting and unique among animal viruses. It causes viral hepatitis D only in individuals already infected with HBV (hepatitis B). This dual infection leads to the most aggressive hepatic dysfunction of all human viral hepatitis.AIM: This study was made to outline the hepatitis D virus among patients with chronic liver disorders in northeastern Bulgaria, in the sight of virus epidemiology, pathogenicity and viral genotype.

Epidemiology Pattern, Prevalent Genotype Distribution, Fighting Stigma and Control Options for Hepatitis D in Bulgaria and Other European Countries

“…We found 16.6% (n = 65) of them to be anti-HDV positive. We found HDV RNA positive results in 96.9% of all the anti-HDV Ab (+) patients, which was close to the results reported by EASL, according to which 87% of anti-HDV positive serum samples are also hepatitis D nucleic acid positive [45,77,78]. A study carried out for 788 inmates in five Bulgarian prisons during the period 2018-2019 showed an overall rate of antibody positivity for anti-HDV to be 10.86% (n = 84).…”

“…The relative proportion of HDV-infected immigrants has been increasing in relation to HDV-infected natives, interrupting the decline in HDV. The prevalence has been stabilised at 8-10% in Germany, Italy, Spain and France over the last 10-15 years, where over 75% of the immigrants came from Turkey, Eastern Europe and the former Soviet Union [13,77]. This contemporary pattern of decreasing domestic and increasing migrant HDV infections has been observed in all high-income countries in Europe, presenting a challenge for healthcare systems [71].…”

“…In recent years, the incidence of acute HDV infection in Europe has decreased due to the successful implementation of HBV vaccination programs. A number of studies indicate that, compared to HBV monoinfection, HBV/HDV co-infection is usually transient and self-limited, and the disease becomes chronic HDV in about 10% of the cases [77]. In case of chronification, a more severe clinical course is frequent, and two peaks of serum ALT and AST may be observed [83].…”

“…The genotype assignment was based on the analysis of the sequences that corresponded to nucleotides between 906 and 1256. When comparing the obtained HDV sequences with sequences correlating to HDV from the BLAST (basic local alignment search tool) database in NCBI (National Center for Biotechnology and Information), they were all closely related to HDV-genotype 1 [95,96].…”

“…When the participants were asked if they had been discriminated against because of their chronic suffering, 90% of the respondents answered positively. The most frequently reported areas of life of chronic hepatitis D patients reported in the survey and marked by stigma were discrimination from society (67.0%), healthcare professionals (18.5%) and institutions (14.5%) [78,114]. The reported results coincided with those reported by the World Hepatitis Alliance, where more than 90% of surveyed patients in different countries reported stigma and discrimination: 53% of respondents are socially isolated; 1 in 2 people were restricted from receiving quality healthcare; and 42% lost their job or income.…”