A re-assessment of the epidemiology and patient characteristics of hepatitis D virus infection in inner city London.

OBJECTIVES: To re-assess the prevalence and patient characteristics of hepatitis D virus (HDV) infection among hepatitis B patients in inner city London. METHODS: All hepatitis B patients attending clinics over a 52 months period were tested for HDV antibody. All reactive samples were also tested for anti-HDV IgM and RNA. The characteristics of HDV seronegative patients first seen in the calendar year 2008 were compared with all HDV seropositive patients in the cohort. RESULTS: Of 1048 hepatitis B patients, 11 had equivocal anti-HDV serology (1%) and 22 were HDV seropositive (2.1%, 95%CI 1.39-3.16%); 12 were anti-HDV IgM positive and 15 HDV RNA positive. No patient with equivocal anti-HDV serology had detectable HDV RNA. Five HDV seropositive patients were intravenous drug users (22.7%); 17/22 were from abroad with 11/22 (50%) from sub-Saharan Africa. HDV seropositive patients had poorer laboratory parameters and were more likely to have evidence of cirrhosis. Triple infected (HIV/HBV/HDV) patients were also more likely to have cirrhosis than HIV/HBV dually infected patients. CONCLUSIONS: The prevalence of HDV in hepatitis B patients in inner city London was about 2%. The role of migration from endemic countries should be recognised.

African links and hepatitis B virus genotypes in the Republic of Yemen.

Hepatitis B virus (HBV) genotypes in three different communities in the Republic of Yemen with and without significant African links were studied. The subjects included indigenous Yemeni blood donors (n = 987), Africans who had settled down in Yemen for several generations (n = 97) and Soqotrans living on an island in the Indian Ocean close to the African coast (n = 99). Phylogenetic analysis of HBV surface region sequences showed the presence of two major genotypes; A and D: sequences from the blood donors were all genotype D (17/17); those from Africans residing in Yemen were predominantly genotype D (7/8) although one sequence was genotype A; whereas a mixture of genotype A and D was found among the Soqotrans (5/8 and 3/8 respectively). Genotype A sequences were associated with higher viral load, but the difference was not statistically significant. Human migration and international travel, may lead to an interaction between HBV genotypes. The Republic of Yemen is at a location where genotypes A and D meet. The results from this study suggest that genotype A is found only in communities with continuing African links and that genotype D remains the dominant genotype in settled populations. More studies are needed to examine possible long-term changes in HBV genotypes in this region.