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Detection of Low Copy Number Integrated Viral DNA Formed by In Vitro Hepatitis B Infection
Published on: November 7, 2018
Coinfection with hepatitis B and D: epidemiology, prevalence and disease in patients in Northern California
Robert G Gish1, Debbie Hana Yi, Steve Kane
1Section of Hepatology, Division of GI, Department of Medicine, University of California, San Diego, San Diego, California, USA; Center for Hepatobiliary Disease and Abdominal Transplantation, University of California, San Diego, San Diego, California, USA.
Insights
Hepatitis Delta virus (HDV) coinfection in chronic hepatitis B (CHB) patients is common, with higher cirrhosis rates. Screening all CHB patients for HDV is recommended to guide treatment and prevent transmission.
Area of Science:
- Hepatology
- Virology
- Infectious Diseases
Background:
- Hepatitis Delta virus (HDV) infection prevalence and impact in the US remain understudied.
- Chronic hepatitis B virus (CHB) patients are a key population for assessing HDV coinfection.
Purpose of the Study:
- To assess the prevalence and characteristics of HDV coinfection in CHB patients.
- To evaluate clinical presentation, hepatitis C virus (HCV) tri-infection rates, and HDV viral load.
- To inform revised screening guidelines for HDV in CHB patients.
Main Methods:
- Retrospective chart review of CHB patients at California Pacific Medical Center.
- Analysis of HDV testing, coinfection status, and demographic data.
- Assessment of HBV-DNA levels and cirrhosis prevalence.
Main Results:
- 8% of tested CHB patients were coinfected with HDV; 50% of these were also infected with HCV.
- Cirrhosis rates were significantly higher in coinfected (73%) and tri-infected (80%) patients compared to monoinfected (22%).
- HDV affected diverse ethnic groups; HBV viral loads varied, with many undetectable.
Conclusions:
- HDV infection occurs across various demographics and is associated with increased cirrhosis risk in CHB patients.
- Higher cirrhosis rates observed in tri-infected (HBV, HDV, HCV) patients underscore disease severity.
- Universal HDV screening for CHB patients is recommended for improved patient management and public health.
Background And Aims:
With no report on the overall prevalence and ramifications of hepatitis Delta virus (HDV) infection in the United States for more than two decades, the characteristics of chronic hepatitis B virus (CHB) patients coinfected with HDV, including clinical presentation, rate of hepatitis C virus tri-infection, and HDV viral load, were assessed.
Methods:
At California Pacific Medical Center, a retrospective chart review was conducted on all CHB patients.
Results:
Of 1191 CHB patients, 499 had been tested for HDV, with 42 (8%) determined to be coinfected; half of these were also hepatitis C virus-infected. Cirrhosis was present in 73% of the coinfected, 80% of the tri-infected, but only 22% of the monoinfected. Twenty-nine patients (69%) were Caucasian non-Hispanic; 10 (24%) were Asians and Pacific Islanders. Of 39 patients for whom HBV-DNA quantification at time of HDV presentation was available, 22 (56%) had undetectable levels; four (10%) had levels > 100 000 IU/mL.
Conclusions:
HDV affects individuals of all ages and various ethnic groups. Although HBV viral loads are lower, rates of cirrhosis are higher in coinfected patients and higher still in the tri-infected. Our data support revising screening guidelines to advocate for all patients with HBV to be screened for HDV in order to both give the individual patient important information related to the possible need for treatment and to support the public health goal of reducing transmission by educating HDV-negative patients about the need for protection against superinfection and HDV-infected patients about the need to protect against transmission to others.
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