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Estimated number of international migrants according to the UN as of 2017, and migrants as the percentage of the total population in industrialized countries (Adapted from United Nations, International Migration Report 2017 22 ) Major area, region, or country Number of international migrants (thousands) Migrants as percentage of total population
Source publication
Within the hepatitis virus landscape, one incomplete virus, the hepatitis delta virus (HDV), appears to differ from hepatitis B and C viruses in the context as it still may not infrequently lead to complications of chronic liver disease and continues to be associated with significant liver-related mortality even when patients have received availabl...
Contexts in source publication
Context 1
... 1985 20 and continue to rise in the 21 st century 21,22 . The estimated number of international migrants rose from 173 million in 2000 by more than 50% and reached 258 million in 2017 (3.4% of the world population) and 272 million in 2019 (Table 1) 21,22 . The number of PWIDs is estimated from 10.6 million to more than 15 million (0.2% of the world population) ( Table 2) 23,24 . ...Context 2
... it suggests that PWID on a global scale represents roughly 5% of the high-risk group pool, in particular when immigrants are considered. Immigrants reside mainly in high-income countries and represent more than 10% of the general population in industrialized countries except China (Table 1) and Far East countries (data not shown). In addition, other high-risk groups worth mentioning may be individuals with highrisk sexual behavior and incarcerated people. ...Context 3
... a 2010 report, relevant prevalence figures for Italian versus immigrants were 4.2 and 17% 38 and this year (2020) in a nationwide survey of 9 tertiary centers, 33 it was 6.4 and 26.4%, respectively. Italy and Spain compared to other West European countries appear to have recognized the migration factor in HDV rather recently, in line with the sharp increase in immigrants since 2000 (Table 1). ...Context 4
... 1985 20 and continue to rise in the 21 st century 21,22 . The estimated number of international migrants rose from 173 million in 2000 by more than 50% and reached 258 million in 2017 (3.4% of the world population) and 272 million in 2019 (Table 1) 21,22 . The number of PWIDs is estimated from 10.6 million to more than 15 million (0.2% of the world population) ( Table 2) 23,24 . ...Context 5
... it suggests that PWID on a global scale represents roughly 5% of the high-risk group pool, in particular when immigrants are considered. Immigrants reside mainly in high-income countries and represent more than 10% of the general population in industrialized countries except China (Table 1) and Far East countries (data not shown). In addition, other high-risk groups worth mentioning may be individuals with highrisk sexual behavior and incarcerated people. ...Context 6
... a 2010 report, relevant prevalence figures for Italian versus immigrants were 4.2 and 17% 38 and this year (2020) in a nationwide survey of 9 tertiary centers, 33 it was 6.4 and 26.4%, respectively. Italy and Spain compared to other West European countries appear to have recognized the migration factor in HDV rather recently, in line with the sharp increase in immigrants since 2000 (Table 1). ...Similar publications
Background and Aims
Hepatitis delta virus (HDV) is a defective virus and causes severe liver disease. Several HDV RNA assays have been developed, however the diagnostic efficacy remains unclear.This systematic review and meta-analysis aims to evaluate the diagnostic accuracy of HDV RNA assays to aid in the diagnosis of active hepatitis D.
Methods...
Citations
... However, the patterns of transmission in developed countries are changing due to the introduction of HBV vaccines, safer sex behaviors (precipitated by HIV fear, and the declining rates of risky sexual encounters due to public health campaigns), the widespread practice of proper sterilization of equipment, and the ease of availability of disposable Class II medical products such as syringes. Prevalence, and therefore transmission, nonetheless remains higher amongst PWID, hemodialysis recipients, MSM, sex workers, and immigrants from areas of high HDV endemicity [5,20]. The lack of universal screening of chronic hepatitis B patients for hepatitis D fails to detect infection in these countries and may facilitate transmission in high-risk populations. ...
... Young adults (18)(19)(20)(21)(22)(23)(24)(25) have also been shown to be at severe risk of disease progression. Approximately a third of patients had cirrhosis at presentation, suggesting an aggressive course of disease [59]. ...
Epidemiological studies and recent metanalyses addressing hepatitis D have reported a wide variation in the prevalence of the disease. Between 4.5% to 15% of all hepatitis B surface antigen (HBsAg) positive patients are thought to harbor the hepatitis D virus. The emergent variation in prevalence can be attributed to several factors. Unsurprisingly, published literature shows that the prevalence of the disease is higher in areas where aggregate viral hepatitis infections are endemic and amongst groups with high-risk practices facilitating the horizontal transfer. Meanwhile, the natural history of the disease is influenced by the genotype of the virus, the hepatitis D virus (HDV) RNA levels, HBV-HDV codominance, HBsAg titers, HBV genotype, nutritional status, HIV co-infection, and prior treatment. Together these factors contribute to the accelerated development of fibrosis and the increased risk of hepatocellular carcinoma. Superinfection with genotype 1 results in rapid progression to cirrhosis with lower rates of remission. Genotype 3 follows an aggressive course but shows a good response to interferon therapy. Other genotypes have better outcomes. The course of the disease leading to these outcomes can be tracked by HDV-specific models integrating clinical surrogate markers and epidemiological factors such as age, region, alanine aminotransferase (ALT), gamma-glutamyl transferase, albumin, platelets and cholinesterase, and liver stiffness.
... Delta infection still causes health and economic problems, particularly in endemic countries. HDV infection is associated with HBV epidemiology and is significantly more common with intravenous drug use, multi-partner sexual behaviors, anti-HIV positivity, anti-HCV positivity, men who have sex with men, healthcare workers, immigrant people moving from high endemic areas, prisoners, hemophiliacs, poor hygienic conditions, and in those living in low economic income countries (14,15,16,51,83,84,85). Hence, delta infection continues stably 5-10% in patients with HBsAg carriers. ...
... Since the first discovery of the HDV in 1977 [29], it is estimated that 15 million to 20 million people have been infected worldwide [30,31]. Given that HDV is a defective virus dependent on the envelope proteins of HBV for assembly and release of infectious virus particles, HDV infection occurs either with or secondary to HBV infection. ...
Background
Hepatitis delta virus (HDV) is a satellite RNA virus that relies on hepatitis B virus (HBV) for transmission. HIV/HBV/HDV coinfection or triple infection is common and has a worse prognosis than monoinfection.
Objective
We aimed to reveal the epidemiological characteristics of HIV/HBV/HDV triple infection in the global population.
Methods
A systematic literature search in PubMed, Embase, and the Cochrane Library was performed for studies of the prevalence of HIV/HBV/HDV triple infection published from January 1, 1990, to May 31, 2021. The Der Simonian-Laird random effects model was used to calculate the pooled prevalence.
Results
We included 14 studies with 11,852 participants. The pooled triple infection rate in the global population was 7.4% (877/11,852; 95% CI 0.73%-29.59%). The results of the subgroup analysis showed that the prevalence of triple infection was significantly higher in the Asian population (214/986, 21.4%; 95% CI 7.1%-35.8%), in men (212/5579, 3.8%; 95% CI 2.5%-5.2%), and in men who have sex with men (216/2734, 7.9%; 95% CI 4.3%-11.4%). In addition, compared with people living with HIV, the HIV/HBV/HDV triple infection rate was higher in people with hepatitis B.
Conclusions
This meta-analysis suggests that the prevalence of HIV/HBV/HDV triple infection in the global population is underestimated, and we should focus more effort on the prevention and control of HIV/HBV/HDV triple infection.
Trial Registration
PROSPERO CRD42021273949; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=273949
... However, new therapies, such as lonafarnib (a prenylation inhibitor) and bulevirtide (a receptor blocker or viral entry inhibitor), demonstrating improved effectiveness in comparison to IFNa, 5 are currently in clinical trials or have received conditional approval. 6 Screening for HDV infection is recommended in HBsAg-positive individuals, particularly in patients from HDV endemic regions, 7,8 those having a history of high-risk (injection drug use, sexual contact) behaviours, 9 or who display abnormal liver biochemistry in the presence of low or undetectable HBV DNA. 10 There are 8 HDV genotypes (gt1-gt8), all having distinct geographic distribution other than gt1. 11 The true prevalence and distribution of HDV seroprevalence and active infection is uncertain, with estimates that vary significantly. ...
Background and Aims
Hepatitis D virus (HDV) affects 4.5% to 13% of chronic hepatitis B (CHB) patients globally, yet the prevalence of HDV infection in Canada is unknown. To investigate the prevalence, genotype, demographic and clinical characteristics of HDV in Canada, we conducted a retrospective analysis of (1) HDV antibody and RNA positivity among referred specimens, and (2) a cross-sectional subset study of 135 HDV seropositive +/-RNA (HDV+) patients compared with 5,132 HBV mono-infected patients in the Canadian HBV Network.
Methods
Anti-HDV IgG-positive specimens collected between 2012 and 2019 were RNA tested and the genotype determined. Patients enrolled in the Canadian HBV Network were >18 years of age and HBsAg-positive. Clinical data collected included risk factors, demographics, comorbidities, treatment, fibrosis assessment and hepatic complications.
Results
338/7,080 referred patients (4.8%, 95% CI 4.3-5.3) were HDV seropositive, with 219/338 RNA positive (64.8%, 95% CI 59.6-69.7). The HDV+ cohort were more likely to be born in Canada or a country non-endemic for HBV, White or Black/ African/ Caribbean than Asian, and reporting high-risk behaviours, compared to HBV mono-infected patients. Cirrhosis, complications of end-stage liver disease and liver transplantation were significantly more frequent in the HDV+ cohort. HDV viremia was significantly associated with elevated liver transaminases and cirrhosis. Five HDV genotypes were observed among referred patients but no association between genotype and clinical outcome was detected within the HDV+ cohort.
Conclusions
Nearly 5% of the Canadian HBV referral population is HDV seropositive. HDV infection is highly associated with risk behaviours and both domestic and foreign-born CHB patients. HDV was significantly associated with progressive liver disease highlighting the need for increased screening and surveillance of HDV in Canada. Word count: 273
Lay Summary
Evidence of hepatitis D virus (HDV) infection was observed in approximately 5% of hepatitis B virus (HBV)-infected Canadians referred to medical specialists. HDV positive patients were more likely to be male, born in Canada or an HBV non-endemic country, White or Black/African/Caribbean compared to Asian, and to have reported high risk activities such as injection or intranasal drug use or high-risk sexual contact compared to patients infected with only HBV. Patients infected with HDV were also more likely to suffer severe liver disease, including liver cancer, compared to HBV mono-infected patients.
... In such countries, HDV is, similar to the past, a disease of high-risk groups but in variance with the past, main risk factor today is migration from endemic countries. 8 In this context, a clinician today should be aware of viral factors affecting disease severity. Genotype 3 (G3) HDV observed in South America leads to more severe, and G2 and G5 HDV seen in Asia and Africa, respectively, lead to milder disease compared to G1 HDV. ...
LINKED CONTENT
This article is linked to Palom et al paper. To view this article, visit https://doi.org/10.1111/apt.16485
Objectives
Hepatitis delta virus (HDV) infection has been granted orphan disease status by the US Food and Drug Administration and the European Medicines Agency owing to its rarity and relatively limited research and treatment options. Turkey is considered an endemic country for the virus. We aimed to provide a current and updated country- and region-specific HDV infection prevalence.
Methods
In this meta-analysis, we searched databases, including MEDLINE, PUBMED, EMBASE, and UlakBim (Turkish Medical Index) published between January 1, 2006, and December 31, 2022. We included blood donor studies, outpatient clinic studies that comprised patients without cirrhosis, and inpatient clinical studies that comprised patients with cirrhosis. Turkey was divided into three regions: West, Central, and East Turkey.
Results
After a systematic assessment, 41 studies were included. Using a random-effects model, the estimated HDV prevalence among hepatitis B surface antigen–positive blood donors, outpatient clinic, and inpatient clinic patients were 3.37% (confidence interval [CI] 1.99-6.11), 5.05% (CI 4.00-6.23), and 29.06% (CI 10.45-51.79), respectively. The HDV prevalence among outpatient clinic patients in Western, Central, and Eastern regions were 3.38% (CI 2.47-4.44), 2.15% (CI 1.37-3.09), and 9.81% (CI 6.61-13.55), respectively.
Conclusions
East Turkey continues to have a high burden of HDV. Public health efforts, such as screening, should be targeted accordingly.
Rationale: The high prevalence of hepatitis D virus (HDV) infection in the Republic of Dagestan, significantly exceeding that in the European part of the Russian Federation, as well as the limited choice of therapeutic options, have led to the need to analyze the accumulated experience of interferon therapy in the real clinical practice to further select possible treatment regimens. Aim: To evaluate the efficacy of pegylated interferon alpha (Peg-IFN-) in patients with chronic hepatitis D (CHD) in real world clinical practice. Materials and methods: In a retrospective study, the efficacy, safety and tolerability of Peg-IFN- were analyzed in 34 patients with CHD living in the Republic of Dagestan. Main virological parameters (anti-HDV antibodies (anti-HDV), HDV RNA and HBV DNA), alanine aminotransferase levels, changes over time in liver density by elastometry, and clinical parameters (hematology and urine tests, clinical chemistry, thyroid function tests) were assessed at 24 and 48 weeks of therapy, as well as at 48 weeks after its completion. Results: The treatment with Peg-IFN- for 48 weeks resulted in a virological response, defined as a HDV RNA decrease by more than 2 lg copies/mL, in 32% (11/34) of the patients. A sustained virological response, defined as undetectable HDV RNA at 48 weeks after the end of therapy, was not observed in any case. Treatment with interferon was associated with a decrease in liver density by average 4.1 kPa by week 48 on therapy. Normalization of alanine aminotransferase levels after 48 weeks of treatment was observed in 59% (20/34) of the patients; however, sustained biochemical response was achieved in none of them. Serious adverse events of high or moderate severity that resulted in the discontinuation of therapy were observed in 12% (4/34) of the cases. Conclusion: The results obtained indicate low efficacy of Peg-IFN- in the treatment of CHD in the Dagestan patients. Further research is needed to refine optimal interferon therapy regimens, to search for predictors of treatment response, and to evaluate the impact of interferon treatment regimens on the risk of hepatic complications, clinical outcomes, and patient survival. However, the most obvious solution to the problem of CHD therapy is the development and implementation of interferon-free treatment regimens.
Introduction:
Chronic hepatitis delta (CHD) is the most severe form of chronic viral hepatitis. Until recently, its treatment consisted of pegylated interferon alfa (pegIFN) use.
Areas covered:
Current and new drugs for treating CHD. Virus entry inhibitor bulevirtide has received conditional approval by the European Medicines Agency. Prenylation inhibitor lonafarnib and pegIFN lambda are in phase 3 and nucleic acid polymers in phase 2 of drug development.
Expert opinion:
Bulevirtide appears to be safe. Its antiviral efficacy increases with treatment duration. Combining bulevirtide with pegIFN has the highest antiviral efficacy short-term. The prenylation inhibitor lonafarnib prevents hepatitis D virus assembly. It is associated with dose dependent gastrointestinal toxicity and is better used with ritonavir which increases liver lonafarnib concentrations. Lonafarnib also possesses immune modulatory properties which explains some post-treatment beneficial flare cases. Combining lonafarnib/ritonavir with pegIFN has superior antiviral efficacy. Nucleic acid polymers are amphipathic oligonucleotides whose effect appears to be a consequence of phosphorothioate modification of internucleotide linkages. These compounds led to HBsAg clearance in a sizeable proportion of patients. PegIFN lambda is associated with less IFN typical side effects. In a phase 2 study it led to 6 months off treatment viral response in one third of patients.
Chronic viral hepatitis B, C, and D are the main causes of decompensated cirrhosis and liver cancer worldwide. Newborn HBV vaccination was implemented more than 2 decades ago in most EU countries. Furthermore, potent oral antivirals have been available to treat HBV for 15 years and to cure HCV since 2014. The real-life clinical benefits of these interventions at country level have not been assessed, especially regarding major hepatic outcomes such as cirrhotic decompensation events and hepatocellular carcinoma (HCC).
Retrospective study of all hospitalizations in Spain having HBV, HCV, and HDV as diagnosis using the Spanish National Registry of Hospital Discharges. Information was retrieved from 1997 up to 2017.
From a total of 73,939,642 hospital admissions during the study period, a diagnosis of HBV, HCV, and HDV was made in 124,915 (1.7‰), 981,985 (13.3‰), and 4850 (0.07‰) patients, respectively. The median age of patients hospitalized within each group was 53.2, 55.9, and 47.0 years, respectively. Significant increases in mean age at hospitalization occurred in all groups (0.6 years older per calendar year on average).
The overall rate of hepatic decompensation events for HBV, HCV, and HDV was 12.1%, 14.1%, and 18.8%, respectively. For HCC hospitalizations, these figures were 6.7%, 8.0%, and 7.8%, respectively. Whereas, the rate of decompensation events declined in recent years for HBV, and more recently for HCV, it continued rising up for HDV. Likewise, liver cancer rates recently plateaued for HBV and HCV, but kept growing for HDV.
The rate of hepatic decompensation events and liver cancer has declined and/or plateaued in recent years for patients hospitalized with HBV and HCV infections, following the widespread use of oral antiviral therapies for these viruses. In contrast, the rate of decompensated cirrhotic events and HCC has kept rising up for patients with hepatitis delta, for which effective antiviral treatment does not exist yet.
