Saturday, August 24, 2013

Coinfection with hepatitis B and D: Epidemiology, prevalence and disease in patients in Northern California

This is an important study for many reasons:
  • Note: The hepatitis D virus (HDV) needs the hepatitis B virus in order to replicate.
  • The prevalence of HDV is unknown in the United States so this small study is important because it sheds some light on HDV in this one center and speaks to the need for better surveillance.
  • Of the 499 patients in the study, 8% were coinfected with HBV/HDV; half of the HBV/HDV were also infected with hepatitis C.
  • 73% of the people coinfected with HBV/HDV had cirrhosis; 80% had cirrhosis in the HBV/HDV/HCV coinfected group
  • Of those with HBV/HDV 69% were Caucasian non-hispanic; 24% were Asian/Pacific Islanders. 
Based on the data from this study the authors recommended that people with HBV should screened for HDV.

HDV is a blood-borne virus so strategies to prevent transmission of other blood borne viruses (HIV, HBV, HCV) will prevent the transmission of HDV. To prevent person-to-person transmission practice safer sex, do not share needle or works, cover all wounds, and as mentioned above get vaccinated against HBV if not already protected. Another good strategy for prevention is to always put a barrier between your blood and other people’s blood. - AF

Journal of Gastroenterology and Hepatology, Volume 28, Issue 9 Pages v - viii, 1431 - 1584, September 2013

Coinfection with hepatitis B and D: Epidemiology, prevalence and disease in patients in Northern California

Robert G Gish. Debbie Hana, Steve Kane, Margaret Clark, Michael Mangahas, Sumbella Baqai, Mark A Winters, James Proudfoot, Jeffrey S Glenn

© Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd, Article first published online: 22 AUG 2013


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.

At California Pacific Medical Center, a retrospective chart review was conducted on all CHB patients.

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.

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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