Identificación del virus de hepatitis delta genotipo 3 en comunidades andinas y amazónicas del Perú

Introducción. El virus de la hepatitis delta (VHD) es el causante de la forma más severa de la hepatitis viral humana, se asocia con un riesgo alto de fibrosis al hígado y carcinoma hepatocelular (HCC). Existen 8 genotipos del VHD con diferente distribución geográfica. Objetivos. Identificar los genotipos del VHD circulante en Huanta y tres pueblos indígenas de la Amazonía peruana. Métodos. Estudio observacional y transversal, realizado en 582 muestras reactivas para anti-HBc del VHB. Por el método nRT-PCR se procesaron todos los anti VHD positivos, el genotipo fue determinado mediante secuenciamiento directo tipo Sanger y análisis filogenético del fragmento R0. Se utilizaron 111 secuencias de referencia del GenBank. Las 42 secuencias del estudio fueron editadas y ensambladas con programas bioinformáticos. El análisis filogenético y evolutivo se realizó con los programas: Beast V2.5.2, Jmodeltest v2.1.10, Tracer v1.7.1, Tree Annotator y Figtree v1.4.4. Se utilizaron los modelos Bayesianos Yule y Birth Death skyline serial, el MCMC en 30 y 80 millones respectivamente, con el relaxed uncorrelated Exponential molecular clock. Se calcularon las medidas de resumen y de tendencia central utilizando el programa en STATA 14.0. Resultados. La media de la edad fue de 38 años, el 52,8% fueron mujeres. 101 muestras fueron positivas para anticuerpos anti-VHD. El ARN del VHD fue detectado en el 49,5% de las muestras reactivas a ELISA anti-VHD. El análisis filogenético determinó la presencia del genotipo 3. Conclusiones. Se evidencia la presencia del genotipo 3 del VHD en comunidades andinas y amazónicas del Perú.

Introduction. The Hepatitis Delta Virus (HDV) is the cause of the most severe form of human viral hepatitis and is associated with a high risk of liver fibrosis and hepatocellular carcinoma (HCC). There are 8 HDV genotypes with different geographic distribution. Objectives. To identify the genotypes of VHD circulating in Huanta and three indigenous peoples of the Peruvian Amazon. Methods. Observational and cross-sectional study, from 582 reactive samples for anti-HBc-HBV. Anti-HDV positive samples were processed with the nRT-PCR method, genotype was determined by direct Sanger-type sequencing and phylogenetic analysis of the R0 fragment. 111 reference sequences from GenBank were used. The 42 sequences of the study were edited y assembled with the bioinformatics programs. Phylogenetic and evolutionary analysis was performed with the following software: Beast v2.5.2, Jmodeltest v2.1.10, Tracer v1.7.1, Tree Annotator and Figtree v1.4.4. The Bayesian Yule and Birth Death skyline serial models were used, the MCMC at 30 and 80 million respectively, with the relaxed uncorrelated Exponential molecular clock. Summary and central tendency measures were calculated using the program in STATA 14.0. Results. The mean age was 38 years, 52.8% were women. 101 samples were positive for anti-HDV antibodies. HDV RNA was detected in 49.5% of the anti-HDV ELISA reactive samples. Phylogenetic analysis determined the presence of genotype 3. Conclusions. The presence of HDV genotype 3 in Andean and Amazonian communities of Peru is evidenced.

Epidemiological situation of hepatitis D in the gathering area of Mongolian population in Inner Mongolia Autonomous Region of China / 临床肝胆病杂志

Objective To investigate the status and molecular epidemiology of hepatitis D virus (HDV) infection in the gathering area of Mongolian population in Inner Mongolia Autonomous Region of China. Methods A total of 230 patients with positive hepatitis B surface antigen (HBsAg) who attended Inner Mongolia International Mongolian Hospital from April 2019 to October 2020 were enrolled, and according to related information, they were divided into hepatitis B+liver cirrhosis group( n =18) and hepatitis B group( n =212). According to HBsAg quantification with a cut-off value of 250 IU/mL, the patients were divided into HBsAg < 250 IU/mL group( n =104) and HBsAg ≥250 IU/mL group( n =126). ELISA was used to detect HDV antibody, and quantitative real-time PCR was used to measure HDV RNA in patients with positive HDV antibody. Genotyping was performed for HDV RNA-positive samples. The chi-square test was used for comparison of categorical data between two groups. Results The positive rate of HDV antibody was 16.09%, and among the patients with positive HDV antibody, the positive rate of HDV RNA was 91.89%. Among the 18 patients with hepatitis B and liver cirrhosis, the positive rate of HDV antibody was 44.44%, and among the patients with positive HDV antibody, the positive rate of HDV RNA was 100%. There were 104 patients with HBsAg < 250 IU/mL, among whom only 3 patients (2.88%) were positive for hepatitis D antibody, and there were 126 patients with HBsAg ≥250 IU/mL, with a positive rate of HDV antibody of 26.98%. Genotype 1 was observed in all the samples that could be genotyped. Conclusion There is a relatively high infection rate of HDV in Inner Mongolia Autonomous Region, especially in patients with HBsAg ≥250 IU/mL or those with liver cirrhosis. It is necessary to strengthen the detection of hepatitis D in HBsAg-positive patients and perform early diagnosis and treatment to prevent the further progression of hepatitis.

Screening of hepatitis D virus in blood donors in Dalian / 中国输血杂志

【Objective】 To investigate the prevalence of hepatitis D virus in Dalian blood donors. 【Methods】 The samples reactive to HBV in blood screening were selected with the following confirmed results: 1)HBsAg+ &HBV DNA+ ; 2)HBsAg+ & HBV DNA-; 3)HBsAg-&HBV DNA+ ; 4)NAT-yield uncertain. Qualified samples in routine blood screening were additionally tested with anti-HBc+ and anti-HBs+. All samples selected were tested HDV IgG further. Initial reactive samples would be tested by another HDV IgG assay and HDV IgM assay. HDV IgG positive was confirmed when samples were reactive to two HDV IgG assays. 【Results】 None HDV antibodies were detected among 1 344 unqualified samples (507 HBsAg+ &HBV DNA+, 33 HBsAg+ &HBV DNA-, 477 HBsAg-&HBV DNA+ and 327 NAT-yield uncertain samples) or 766 qualified samples (397 anti-HBc+ and 369 anti-HBs samples) in blood screening. 【Conclusion】 The prevalence of HDV infections among Dalian blood donors eligible in pre-donation screening seemed extremely low. However, for areas with high HBV prevalence, the risk of blood safety caused by OBI co-infection with HDV should not be ignored.

Key points of EASL Clinical Practice Guidelines on hepatitis delta virus （2023） / 临床肝胆病杂志

‍Due to significant innovations in the diagnosis and treatment of hepatitis D virus （HDV）， the European Society of Hepatology （EASL） published its first international clinical practice guidelines on the management of individuals with HDV infection in July 2023. The guidelines mainly focus on the six aspects of HDV screening， diagnosis， clinical features and influencing factors， patient monitoring and selection for treatment， therapeutic methods and treatment endpoints. The guidelines give recommendations by answering and elaborating on 13 questions covering these six aspects. In addition， the guidelines also provide the prospect of the future treatment of HDV. The author’s team makes an excerpt of the guidelines and systematically introduces various evaluation points in recommendations and clinical management suggestions， in order to promote the development of clinical management and decision-making for individuals with HDV infection in China.

Epidemiological situation of hepatitis D in Xinjiang, China / 临床肝胆病杂志

Hepatitis D is a global public health issue, and the infection rate and genotype of HDV infection vary greatly across different regions. The overlapping infection of hepatitis D virus (HDV) in patients with chronic hepatitis B virus (HBV) infection can accelerate disease progression, but hepatitis D has not been taken seriously to a large extent. Xinjiang in China is an area with a high incidence rate of hepatitis B, but there is a lack of research on hepatitis D. This article discusses the prevalence of HDV infection in Xinjiang and briefly reviews the prevalence rate of HDV infection in Xinjiang, the molecular epidemiology of HDV among different ethnic groups, and the current status of HDV infection in neighboring countries, so as to provide a reference for the conduct of molecular epidemiological research on HDV and disease prevention and control in Xinjiang.

Detection methods for hepatitis D antibodies: A comparative analysis / 临床肝胆病杂志

Hepatitis D is a severe form of viral hepatitis caused by co-infection with hepatitis D virus (HDV) and hepatitis B virus (HBV) or superinfection of HDV in HBV carriers. There is still a huge gap in the diagnosis of hepatitis D due to insufficient emphasis on this disease for a long time. With the advances in related studies in recent years, the academia and the medical industry have gradually realized the harm of hepatitis D, and meanwhile, breakthroughs in drug development have also brought new opportunities for the treatment or even cure of hepatitis D. These advances greatly increase the demand for the diagnosis of hepatitis D. HDV antibodies are the key markers for the diagnosis of hepatitis D. This article summarizes and compares the detection methods for HDV antibodies including total HDV antibodies, IgG, and IgM and discusses related important issues, so as to understand the current status of the detection of HDV antibodies and provide a reference for developing better diagnostic tools for hepatitis D.

Research history of hepatitis D in China / 临床肝胆病杂志

Since the discovery of hepatitis D virus (HDV) in the 1970s, Chinese scholars have started to conduct extensive studies on HDV and hepatitis D (HD). By searching for related articles published on the platforms of Chinese scientific and technological journals and the journals in PubMed database by Chinese scholars, this article comprehensively analyzes and summarizes the advances and scientific findings in HDV and HD by Chinese scholars from basic to clinical research from the perspective of historical development. Over the past years, Chinese scholars have conducted extensive research on the establishment of detection techniques and methods, the construction of infected animal models, the function and application of ribozymes, and clinical diagnosis and manifestation. The research findings in the past 40 years have laid a foundation for further research on the virological characteristics, infection mechanism, and immune response and injury of HDV, the clinicopathological changes of HD, and related antiviral treatment.

The research on hepatitis D should be taken seriously / 临床肝胆病杂志

Hepatitis D virus (HDV) infection is an important health problem around the world. The epidemiology of HDV infection has been changed significantly over the past 10 years due to widespread hepatitis B vaccination and human migration. HDV infection can manifest as co-infection or superinfection. Patients with HBV/HDV co-infection have a significantly higher risk of liver cirrhosis and hepatocellular carcinoma than those with HBV infection alone. Research and development are being conducted for new therapeutic drugs for hepatitis D, some of which have entered phase Ⅲ clinical trials. These drugs will replace the current therapies with lower efficacy.

Hepatitis D virus seroprevalence in HBsAg positive patients attending a tertiary care hospital in Northeast India

Background:Hepatitis D virus (HDV) infection is present worldwide. Around 18 million people are estimated to be infected with HDV and can infect individuals with active HBV infection and cause severe liver disease. There is lack of data on the prevalence of HDV infection in the state and also in the region. The aim of the study was to determine the seroprevalence of HDV in HBsAg positive patients attending Regional Institute of Medical Sciences Hospital, Imphal, Manipur, India.Methods:This study was carried out in a tertiary care hospital (Regional Institute of Medical Sciences, Imphal).The study was done for a period of 2 years from September 2016 to August 2018. A total of 119 HBsAg ELISA positive cases were included in the study.Results:Out of 119 HBsAg positive cases, 5 cases were positive for hepatitis D antibodies, of which 3 were positive for anti-Hepatitis D virus IgM and 2 were positive for anti-Hepatitis D virus IgG.Seroprevalence of HDV infection was found to be 4.2%.Conclusions:Seroprevalence of HDV infection was found to be 4.2% which is higher than the finding in some of the recent studies in the country.

In vitro study of dendritic cell derived exosomes transporting hepatitis D antigen induced specific cytotoxic T lymphocyte response / 中华传染病杂志

Objective:To explore the effect and mechanism of dendritic cell derived exosomes (Dexs) loading ubiquitinated (Ub) hepatitis D antigen (HDAg) on activating specific cytotoxic T lymphocytes (CTL).Methods:Ub-S-HDAg-Dexs were co-cultured with dendritic cells (DC) which were from the femora of C57BL/6 mice for 48 h, then flow cytometry was used to detect the maturity of DC (CD86, CD80 and major histocompatibility complex (MHC) Ⅱ). The spleen-derived T lymphocytes from C57BL/6 mice were added in vitro to activate DC and co-cultivated for 72 h. The T cells were divided into Ub-S-HDAg-Dexs group (add 50 μg/mL Ub-S-HDAg-Dexs), Blank-Dexs group (add 50 μg/mL DC derived exosomes without plasmid transfection), Con-Dexs group (add 50 μg/mL DC derived exosomes transfected by cantrol plasmid), PBS group (add 50 μL/mL phosphate buffered saline), and Ub-S-HDAg-Dexs+ AG490 group (add 50 μg/mL Ub-S-HDAg-Dexs, DC and T lymphocytes stimulated by exosomes, and 50 μmol/L AG490 was also added to the cell mix). Flow cytometry was used to detect CD8 + T cells secreting interferon-gamma, non-radioactive lactate dehydrogenase release test to detect the killing activity of specific CTL. Real-time quantitative polymerase chain reaction (PCR) and Western blotting were used to detect the mRNA and protein expressions of JAK kinase (JAK) 2, GATA-binding protein 3 (GATA3), T-bet, signal transduction and activator of transcription (STAT) 1 and STAT4. Independent sample t test were used for statistical analysis. Results:The positive rates of the surface molecules CD80, CD86, MHCⅡof DC stimulated by Ub-S-HDAg-Dexs were 83.850%±0.219%、68.910%±0.134%、84.320%±0.445%, respectively.In the Ub-S-HDAg-Dexs group, the rate of CD8 + T cells secreting interferon-gamma was 6.420%±0.028%, which was higher than those of other groups, including PBS group, Blank-Dexs group, Con-Dexs group and Ub-S-HDAg-Dexs+ AG490 group ( t=90.78, 30.32, 63.06 and 85.42, respectively, all P<0.001). The cytotoxicity of T cells in the Ub-S-HDAg-Dexs group was 82.4%±3.9%, which was higher than those of other groups ( t=17.28, 9.74, 3.95 and 15.89, respectively, all P<0.050). The relative mRNA expressions of JAK2, T-bet, STAT1, STAT4 in Ub-S-HDAg-Dexs group were higher than those in other groups, including Con-Dexs group ( t=10.74, 32.34, 13.00 and 16.28, respectively, all P<0.001), Blank-Dexs group ( t=15.05, 21.51, 6.46 and 13.12, respectively, all P<0.050), PBS group ( t=21.83, 41.42, 7.30 and 17.50, respectively, all P<0.050), Ub-S-HDAg-Dexs+ AG490 group ( t=35.75, 20.69, 17.02 and 17.07, respectively, all P<0.001), and the differences were all statistically significant. The protein expressions of T-bet, STAT1, STAT4 in Ub-S-HDAg-Dexs group increased compared with those in PBS group ( t=346.70, 57.54 and 55.81, respectively, all P<0.001), with statistical significance. In the presence of AG490, the protein expressions of T-bet, STAT1 and STAT4 decreased compared with those in Ub-S-HDAg-Dexs group, and the differences were statistically significant ( t=355.40, 52.79 and 126.10, respectively, all P<0.001). Conclusions:Ubiquitinated HDAg transported by exosomes could effectively promote DC maturation, induce T lymphocyte differentiation, and generate specific CTL responses, which provides a new idea for the treatment of hepatitis D.

Seroprevalence of hepatitis B, C and D markers in indigenous patients seen at the Native American Outpatient Clinic of Universidade Federal de São Paulo

ABSTRACT Objective To detect and treat cases of viral hepatitis B, C and D in patients seen at the Native American Outpatient Clinic of Universidade Federal de São Paulo. Methods This sample comprised 81 indigenous recruited between 2018 and 2020. Volunteers were aged 7 months to 70 years (mean age of 28±20 years), belonged to 26 ethnic groups spanning the Brazilian territory and answered a questionnaire, which was attached to their medical records. Peripheral blood samples (20mL) were collected, transported to the Clinical Laboratory of Hospital Israelita Albert Einstein, processed, and tested for markers of viral hepatitis B, C and D. Results In this study, 39 (48.1%) individuals were anti-HBs (+) only, 13 (16.0%) individuals were anti-HBs (+) and anti-HBc (+), and 28 (34.6%) individuals were negative for all markers. No anti-HBc IgM+ samples were found. No cases of hepatitis C and D were found. Conclusion This analysis provided evidence of previous infection by the hepatitis B virus. These findings led to prescription of vaccination against hepatitis B to all participants who were negative for all viral hepatitis B markers, given records of prior hepatitis B vaccination were unreliable.

Research advances in hepatitis D / 临床肝胆病杂志

Hepatitis D virus (HDV) needs hepatitis B virus (HBV) as a helper to infect hepatocytes and spread. Co-infection with HDV and HBV may lead to accelerated progression and poor prognosis, but at present, the hazard and disease burden of HDV infection have been severely underestimated. This article summarizes the research advances in the epidemiology, clinical manifestations, diagnosis, and treatment of HDV infection, in order to provide a reference for more clinicians.

Tendências e distribuição espacial da hepatite D no Norte do Brasil, 2009-2018: um estudo ecológico / Tendencias y distribución espacial de Hepatitis D en el Norte de Brasil, 2009-2018: un estudio ecológico / Trends and spatial distribution of Hepatitis D in the North of Brazil, 2009-2018: an ecological study

Objetivo: Analisar a incidência anual de hepatite D no Brasil e na região Norte, no período 2009-2018. Métodos: Estudo ecológico de casos de hepatite D notificados no Sistema de Informação de Agravos de Notificação (Sinan), analisados por sexo, idade e estados do Norte. Realizou-se análise de tendência temporal pelo método de Prais-Winsten, para estimar a variação percentual anual (VPA) das taxas de incidência. Resultados: No período, foram reportados 2.710 casos no Brasil, 74,5% na região Norte e 71,5% somente no Amazonas, Acre e Rondônia. Houve tendência de queda da VPA no país (-21,6% - IC95% -3,8;-36,2%), região Norte (-28,5% - IC95% -5,2;-46,1%,), Amazonas (-34,1% - IC95% -0,8;-56,2%) e Acre (-37,6% - IC95% -18,0;-52,6%). Verificou-se diminuição de casos nos estratos etários abaixo de 40 anos. Conclusão: Houve tendência de queda da incidência de hepatite D na Amazônia Ocidental, que impactou na incidência no país. Essa redução foi puxada pelos mais jovens, provavelmente resultado da vacinação para hepatite B.

Objetivo: Evaluar la incidencia anual de casos de hepatitis D en Brasil y en la Región Norte, entre 2009-2018. Métodos: En este estudio ecológico, se utilizaron casos notificados al Sistema Nacional de Agravamiento de de Enfermedades (Sinan), analizados por sexo, edad y estados del Norte. Se utilizó la regresión de Prais-Winsten para análisis de la tendencia temporal y el cálculo de la variación porcentual anual (VPA) de tasas de incidencia. Resultados: En el periodo, se notificaron 2.710 casos, siendo 74,5% en el Norte e 71,5% en Amazonas, Acre y Rondônia. Hubo tendencia a disminución de la VPA en Brasil (-21,6% - IC95% -3,8;-36,2%), región Norte (-28,5% - IC95% -5,2;-46,1%,), Amazonas (-34,1% - IC95% -0,8;-56,2%) y Acre (-37,6% - IC95% -18,0;-52,6%). Hubo disminución de casos entre los menores de 40 años. Conclusión: Hubo tendencia a la disminución de la incidencia en la Amazonía Occidental, impactando en la incidencia en Brasil. Esta baja está relacionada con los más jóvenes, probablemente debido a la vacunación contra la hepatitis B.

Objective: To analyze the annual incidence of hepatitis D cases in both Brazil and the Brazilian Northern region between 2009 and 2018. Methods: This was an ecological study of hepatitis cases notified on the Notifiable Health Conditions Information System (SINAN), analyzed by sex, age groups, and Northern region states. Temporal trend analysis was performed using the Prais-Winsten method to estimate incident rate annual percent change (APC). Results: In the period studied, 2,710 cases were reported in Brazil, 74.5% of them in the Northern region and 71.5% in Amazonas, Acre and Rondonia alone. APC showed a downward trend in Brazil as a whole (-21.6% - 95%CI -3.8;-36.2%), in the Northern region (-28.5% - 95%CI -5.2;-46.1%,), in Amazonas (-34.1% - 95%CI -0.8;-56.2%) and in Acre (-37.6% - 95%CI -18.0;-52.6%). Cases decreased in age groups below 40 years old. Conclusion: There was a downward trend in incidence in the Western Amazon, impacting incidence in Brazil as a whole. This fall was led by younger people, probably due to hepatitis B vaccination.

Prevalence of hepatitis B and D virus infection in a district of Mato Grosso, bordering Amazonas and Rondônia states

Abstract INTRODUCTION: Brazil's western Amazon basin has the highest prevalence of hepatitis B virus (HBV) infection in the country. Coinfection with hepatitis D virus (HDV) is also endemic. To estimate the prevalence of HBV and HDV markers in a population inhabiting the northwest portion of Mato Grosso state in the western Amazon. METHODS: We performed a cross-sectional study of the seroprevalence of antibodies against HBV core antigen (anti-HBc) in the Três Fronteiras District northwest of Mato Grosso. Anti-HBc-positive subjects were tested for HBV surface antigen (HBsAg). Those positive for this marker were tested for HDV antibodies. Anti-HBc-negative participants were tested for anti-HBsAg. All tests were performed by EIA. RESULTS: A total of 623 individuals in the community were assessed; the majority (67.6%) were male, with a mean age of 30.8 ± 15.4 years. Two hundred and fourteen individuals (34.3%) were anti-HBc-positive, and 47 (7.5%) were HBsAg carriers. Only one individual was anti-HDV-positive. Among the 409 individuals without HBV infection, 18.3% were anti-HBsAg-positive. There was no association between HBV infection and known risk factors. CONCLUSIONS: The study area had intermediate-to-high endemicity for HBV infection, but a low prevalence of HDV. Our serological results suggesting low vaccination-induced protection indicate a need for reinforced immunization programs in the populations of northwest Mato Grosso.

Research progress on molecular mechanism of hepatitis B virus reactivation after liver transplantation / 器官移植

Liver transplantation is the most effective method for hepatitis B-related liver failure, liver cirrhosis and hepatocellular carcinoma. However, the reactivation of hepatitis B virus (HBV) after liver transplantation is not conducive to the recovery of liver function and leads to poor clinical prognosis. The prevention and treatment of HBV reactivation is currently the focus of research by physicians and surgeons. The current viral suppression strategies can not completely eradicate HBV nor completely prevent the recurrence of HBV infection in the future. This article aims to explore the molecular mechanism of HBV reactivation after liver transplantation, in order to more effectively prevent the recurrence of hepatitis B after liver transplantation.

Hepatitis B and Delta: clinical aspects of patients in the Brazilian Western Amazonia / Hepatitis B y Delta: aspectos clínicos de pacientes en el Amazonas brasileño Occidental / Hepatite B e Delta: aspectos clínicos de pacientes na Amazônia Ocidental brasileira

ABSTRACT Objective: to analyze clinical, serological, biochemical and hematological aspects in patients infected with the hepatitis B (HBV) and Delta (HDV) viruses. Method: cross-sectional, descriptive and retrospective study, performed with patients chronically infected with HBV and superinfected with HDV. Results: among the 112 patients selected, 74% were monoinfected with HBV (Group HBV) and 26% were superinfected with HDV (Group HBV+HDV). There was no difference in gender distribution. The average age was 36 years with standard deviation of ±12 years. The symptoms and signs presented a higher proportion in Group HBV+HDV (p=0.001). In both groups, most patients had non-reactive AgHBe. The records of biochemical and hematologic changes showed highest proportion in Group VHB+VHD Group (p<0.05). Conclusion: the study found that patients were in clinical stages of the disease different from those in the initial examination for monitoring their chronic condition. The clinical profile suggests greater severity of liver disease among the patients superinfected with HDV.

RESUMEN Objetivo: Analizar los aspectos clínicos, serológicos, bioquímicos y hematológicos de pacientes infectados por el virus de las hepatitis B (VHB) y Delta (VHD). Método: Se trata de un estudio transversal, descriptivo, retrospectivo, realizado entre pacientes crónicos infectados de VHB y sobre infectados de VHD. Resultados: Entre los 112 pacientes seleccionados, el 74% estaba mono infectado por VHB (Grupo VHB) y el 26%, sobre infectado por VHD (Grupo VHB+VHD). No se encontró diferencia en la distribución por género. La edad promedio era 36 años, con desviación típica de ±12 años. Los síntomas y signos sobresalían en mayor proporción en el grupo VHB+VHD (p=0,001). Para ambos grupos, la mayoría de los pacientes estaba con AgHBe no reactivo. El registro de alteraciones bioquímicas y hematológicas atribuyó proporción más grande al grupo VHB+VHD (p<0,05). Conclusión: El estudio demostró que los pacientes, en la consulta inicial para el seguimiento de la condición crónica, estaban en diferentes estadios clínicos de la enfermedad. El perfil clínico sugiere que la gravedad de la enfermedad hepática es mayor entre pacientes sobre infectados de VHD.

RESUMO Objetivo: Analisar aspectos clínicos, sorológicos, bioquímicos e hematológicos entre pacientes infectados por vírus das hepatites B (VHB) e Delta (VHD). Método: Estudo transversal, descritivo, retrospectivo, realizado com pacientes cronicamente infectados por VHB e superinfectados por VHD. Resultados: Entre os 112 pacientes selecionados, 74% estavam monoinfectados por VHB (Grupo VHB) e 26% superinfectados por VHD (Grupo VHB+VHD). Não houve diferença na distribuição por gênero. A idade média foi de 36 anos, com desvio padrão de ±12 anos. Os sintomas e sinais apresentaram maior proporção no grupo VHB+VHD (p=0,001). Para ambos os grupos, a maioria dos pacientes estava com AgHBe não reagente. O registro de alterações bioquímicas e hematológicas apresentou maior proporção no grupo VHB+VHD (p<0,05). Conclusão: O estudo revelou que os pacientes estavam em diferentes estágios clínicos da doença na consulta inicial para acompanhamento de condição crônica. O perfil clínico sugere maior gravidade da doença hepática entre os pacientes superinfectados por VHD.

Hepatitis D Virus: An Overview for Dentists

Hepatitis D is considered to be the most severe form of viral hepatitis. This virus requires hepatitis B for its life cycle and it is estimated that at least 5% of hepatitis B virus infected patients are also infected with hepatitis D, counting for 15 million infections worldwide most optimistically. Hepatitis D has a similar transmission pattern to hepatitis B and hepatitis C viruses. However, there is less information about the virus of hepatitis D than aboutthe other agents of viral hepatitis. In particular, there is total lack of information on hepatitis D in the setting of dental diseases and management. To our knowledge, there are only few reports on hepatitis D of dental health care workers (DHCW), the association of hepatitis D with oral conditions and on the role of oral fluid in transmission of hepatitis D. The present report reviews current knowledge of hepatitis D for dentists and dental personnel. Therefore, epidemiology, transmission modes, sign and symptoms, diagnostic methods and treatment options of hepatitis D are discussed under relevant subheadings

Molecular epidemiology of Hepatitis delta virus infection in Minas Gerais state from Brazil, an area outside the hyperendemic region of the Amazon Basin

BACKGROUND Hepatitis delta virus (HDV) infections in hepatitis B virus (HBV) carriers are the most severe form of viral hepatitis. HDV prevalence is high in the Brazilian Amazon, but studies in other regions of the country are still scarce and often underestimated its prevalence by including a small numbers of individuals. OBJECTIVE This study aimed to determine the serological prevalence of hepatitis D, the genotypes circulating and to evaluate the associated risk factors for acquisition of HDV in Minas Gerais state, Brazil. METHODS We screened plasma samples (n = 498) from HBV chronic carriers for anti-HD antibodies using a commercial enzyme-linked immunosorbent assay (ELISA) kit. For those samples that were positive for anti-HD antibodies, we performed a reverse transcriptase (RT) nested-polymerase chain reaction (nested-PCR) in order to detect the viral genome and identify the viral genotypes circulating in the state. FINDINGS The prevalence was 6.22% (31/498). Blood transfusion was the only risk factor associated with HDV infection [risk ratio: 3.73; 95% confidence interval (CI): 1.44 to 9.65]. For 26 anti-HD positive patients, HDAg gene sequences were determined and in all patients HDV genotype 1 was found. CONCLUSIONS This study confirmed the circulation of HDV in Minas Gerais, an area previously considered non-endemic for hepatitis D in Brazil. The prevalence found in this study is much higher when compared to other studies performed in Brazil, probably because the population in our study was selected with minimal bias. Furthermore, in 26 anti-HD positive plasma samples, we were also able to detect the viral genome, indicating that these patients were experienced an active infection at the time of sample collection. These findings emphasise the importance of anti-HD testing in HBV infected individuals, which may contribute to this disease control in Brazil.

Atypical crusted scabies in a patient with chronic liver disease caused by hepatitis B and D viruses

Abstract: Crusted scabies is a less common variant of scabies that is highly contagious, difficult to treat and involves infestation by Sarcoptes scabiei var. hominis. The classical clinical presentation includes crusted, scaly and generally non-pruritic lesions usually located on the head, neck, palmar, plantar and periungual region. It was first described in Norway in 1848 in patients with leprosy who presented with crusted lesions. In this study, we report the case of a patient with crusted scabies with florid clinical manifestations and chronic liver disease due to hepatitis B and delta virus infection.

Evidências científicas sobre a hepatite Delta no Brasil: revisão integrativa da literatura / Scientific evidence on hepatitis Delta in Brazil: integrative literature review

Resumo Objetivo: Descrever o nível de evidência científica sobre a infecção por vírus da hepatite Delta (VHD) no Brasil. Métodos: Revisão integrativa da literatura, com buscas realizadas nas bases de dados do Medical Literature Analysis and Retrieval System Online, Literatura Latino-americana e do Caribe em Ciências da Saúde, Scientific Eletronic Library Online e Scopus, com análise centrada no nivelamento do rigor metodológico de acordo com o modelo de Melnyk e Fineout-Overholt. Resultados: A busca revelou uma média de duas publicações por ano no intervalo entre 1987 e 2017. Foram selecionados 33 artigos, tendo a maioria (91%) apresentado nível de evidência VI. As publicações ficaram concentradas em periódicos da área de medicina tropical (46%) e virologia (15%). Dos trabalhos, 85% tinha profissional médico com autor e o delineamento mais encontrado foi o descritivo/transversal (69,6%). Conclusão: A produção científica sobre a infecção por VHD no Brasil está centrada em estudos de prevalência, mostrando-se incipiente quanto à produção de estudos com delineamentos mais rígidos como ensaios clínicos.

Abstract Objective: Describe the level of scientific evidence on infections by the hepatitis Delta virus (HDV) in Brazil. Methods: Integrative literature review, with research in the databases of the Medical Literature Analysis and Retrieval System Online, Latin American and Caribbean Center on Health Sciences Information, Scientific Eletronic Library Online and Scopus, with analysis focusing on the leveling of the methodological rigor according to the model of Melnyk and Fineout-Overholt. Results: The search revealed an average of two publications a year between 1987 and 2017. We selected 33 articles, the majority (91%) presented level of evidence VI. The publications were concentrated in the area of tropical medicine (46%) and virology (15%). The authors of 85% of the studies were medical professionals and the most common design was the descriptive/cross-sectional (69.6%). Conclusion: Scientific literature on HDV infections in Brazil is focused on prevalence studies, showing incipiency regarding the production of studies with stricter guidelines, such as clinical trials.