Hepatitis Delta virus in migrants: The challenge of elimination (ANRS CO22 HEPATHER cohort)

Abstract

Novel treatments for hepatitis Delta virus (HDV) infection provide promising opportunities to treat patients with hepatitis B virus (HBV) and HDV co-infection. However, current clinical trials on HDV treatment rarely explore patients' barriers to treatments. In Europe, HDV infection mostly affects young migrants from HDV-endemic areas who experience early liver-related mortality. Migrants are more likely to face multiple situations of statutory and socioeconomic insecurity and structural barriers than non-migrants. These obstacles may impact their quality of life and can (i) lead them to give secondary importance to certain HDV care options, (ii) delay treatment initiation and (iii) affect their adherence and commitment to care.Preliminary results from the ANRS CO22 HEPATHER cohort show that the majority (61.6%) of HBV-HDV coinfected migrants live in poverty. Moreover, half were diagnosed and a quarter of those who initiated HBV treatment had been in France for no more than two years, a period when language skills are often still poor and when knowledge of the health and administrative system may be lacking. We advocate for increased social science research, in particular qualitative studies, to investigate the effects that multiple forms of precarity (weak access to social rights, language barriers, housing insecurity, unexpected expenditures and other difficulties) may have on HDV screening opportunities, follow-up, and treatment pathways in migrants. This will help adapt communication and care around viral hepatitis, as well as inform and orient medical services and public health actors about the difficulties that migrants encounter. co-infected; n = 3375 HBV mono-infected.

Autoimmune Hepatitis Induced by Hepatitis Delta Virus: A Conundrum

“…This subject has become increasingly relevant in Europe in recent years as domestic infection, mostly related to intravenous drug use, are being replaced by cases introduced by immigration from endemic areas [3]. Also, the difficulties that we faced in bringing our patient to clinic and starting treatment are in line with reports from the French cohort, where migrant populations were shown to have suboptimal adherence and commitment to care, driven by socioeconomic insecurity [27].…”

Elimination of HDV: Epidemiologic implications and public health perspectives

“…33 HBV and HDV prevention campaigns in Europe are almost non-existent for migrants. 34 Despite constituting the major burden of HDV, this at-risk group is the most marginalized and neglected. Their obstacles push them to give less importance to their disease, which propagates misperceptions about severity of viral hepatitis, causes delays in treatment initiation and weakens their commitment and adherence to care.…”

“…A plethora of factors affect migrants' free access to healthcare such as socioeconomic insecurity, lack of social rights, language barriers, housing insecurity, unexpected expenditures and difficulties 33 . HBV and HDV prevention campaigns in Europe are almost non‐existent for migrants 34 . Despite constituting the major burden of HDV, this at‐risk group is the most marginalized and neglected.…”

The elimination of hepatitis D as a public health problem: Needs and challenges

“…In high‐income countries, in contrast, the epidemiology has shifted from people in older age groups to younger persons, often migrants from countries where HDV infection is endemic. Recent studies performed in France showed that 86% of cases of hepatitis D occurred in migrants 10 . Diagnosis of HDV infection requires the determination of HDV RNA, but the US Food and Drug Administration (FDA), for instance, has no approved assay for HDV RNA or for anti‐HDV antibodies.…”

“…Recent studies performed in France showed that 86% of cases of hepatitis D occurred in migrants. 10 Diagnosis of HDV infection requires the determination of HDV RNA, but the US Food and Drug Administration (FDA), for instance, has no approved assay for HDV RNA or for anti-HDV antibodies. HDV diagnostics are not included in WHO’s list of essential diagnostics.…”