The increasing prevalence of hepatitis delta virus (HDV) infection in South London

Abstract

On the basis of historical studies, hepatitis delta virus (HDV) infection is considered uncommon in the United Kingdom (UK) and mainly confined to intravenous drug users. In order to assess the current prevalence of HDV co-infection in patients with chronic hepatitis B (HBV), a retrospective analysis was performed of 962 consecutive HBV-infected adult patients referred to King's College Hospital between January 1st 2000 and March 31st 2006. The 82 subjects positive for HDV antibody (8.5%) had a similar age to those without HDV (median 36 years, interquartile range 30-47, vs. 35 years, 29-43). Excluding non-UK residents, the prevalence of HDV Antibody was 7.1%. Most HDV-infected subjects were born in regions where HDV is endemic, for example, Southern or Eastern Europe (28.1%), Africa (26.8%) or Middle-East (7.3%). Forty one (50%) were considered to have acquired HDV infection via intra-familial transmission but intravenous drug use was still a common route of transmission (24.4%). Comparing HBV/HDV co-infected to HBV mono-infected patients, a higher proportion were hepatitis C antibody positive (25.6% versus 3.8%; odds ratio 8.89, 95% confidence interval 4.4-17.9; P < 0.00001) and more had cirrhosis (26.8% vs. 12.9%; odds ratio 2.64, 95% confidence interval 1.55-4.49; P < 0.0001) but, despite this, the risk of hepatocellular carcinoma was similar (odds ratio 1.34, 95% confidence interval 0.62-2.91). Although HDV infection is reportedly declining in some endemic regions, our data demonstrate a high prevalence in South London. HDV co-infection is associated with increased morbidity and patients with HBV should be tested for HDV infection.

Hepatitis delta-associated mortality in HIV/HBV-coinfected patients

“…HDV-infected individuals were predominantly PWID of Western European origin, which explains the high proportion of HDV genotype 1 found in our cohort. As all remaining patients (6%) were HDV genotype 5-infected migrants from subSaharan Africa diagnosed during the last five years, our results suggest a changing pattern in HDV epidemiology in Switzerland 2,20,21 . Injection drug use being the most probable route of HDV transmission for the majority of patients included in our study, HCV infection was also present in many of them.…”

“…In cirrhotic HBV-infected patients, Fattovich et al found a 3-fold increase in HCC incidence among HDV-infected patients, whereas similar rates of HCC were found in HBV-and HBV/HDV-infected patients in a retrospective study from London. 20,28 . In Italy, Romeo et al showed that persistent HDV replication was strongly associated with the development of HCC but no HIV-infected individuals were included 8 .…”

British HIV Association guidelines for the management of coinfection with HIV‐1 and hepatitis B or C virus 2010

“…It was previously thought to be rare in the UK and seen mostly in IDUs and their sexual partners. Recent evidence suggests a rising incidence in some areas of the UK, and in one study in South London 8.5% of all HBsAg-positive patients were HDV positive, of whom only 27% had evidence of parenteral exposure [146]. Patients with delta virus superinfection are more likely to have severe hepatitis [147].…”

Characterization of Hepatitis Delta Virus in Sub-Saharan Africa

“…In addition, concurrent infection with HDV complicates viral treatment, as regimens against HBV do not affect HDV replication. Furthermore, HDV infection suppresses HBV replication (22)(23)(24) and reduces HBV DNA in the serum to often undetectable levels, thus complicating the diagnosis and cogenotyping of HBV and HDV strains.…”