Viral Hepatitis B, C and Delta in Greenland: A National Cross-Sectional Study

Viral hepatitis B infection is considered endemic in Greenland as in other Arctic areas. However, updated data are warranted after the implementation of screening, vaccination and treatment programmes during the past decades. We aimed to investigate the prevalence and disease characteristics of chronic viral hepatitis B (HBV), C (HCV) and delta (HDV) in Greenland. We performed a cross-sectional nationwide study using data from the electronic medical records extracted from 2014 to 2023. We identified 299 patients with HBV (positive of HBsAg) and 45 patients with HCV (positive of HCV-Ab and/or HCV-RNA), corresponding to an overall low prevalence of 0.53% (95%-CI: 0.49%-0.57%) and 0.08% (95%-CI: 0.06%-0.11%), respectively. The prevalence of HDV co-infection (positive of HDV-Ab and/or HDV-RNA) among patients with HBV was 9.4%, of whom 82% were HDV-RNA positive, indicating ongoing infection. Most of these patients were middle-aged and male. Additionally, the occurrence of HBV and HCV was higher among women compared to men in the age category 20-39 years. The most recent liver biochemistry, including Fibrosis-4 (FIB4) score, was within reference values among HBV-positive patients, while alanine and aspartate aminotransferase were slightly elevated among HCV-positive patients. A FIB4 score above 1.3 was observed in 28 (9%) with HBV, 2 (7%) of HBV-HDV positive patients, and 16 (36%) with HCV. The prevalence of HBV infection through routine testing in the healthcare system was markedly lower than prevalences reported in previous population screening studies. Yet, HDV co-infection is common and warrants increased awareness. HCV is rare, but more of these patients have elevated liver enzymes and FIB4 scores.