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1.
BMC Infect Dis ; 20(1): 565, 2020 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-32746807

RESUMO

BACKGROUND: Patients coinfected with HBV and hepatitis D virus (HDV) have a greater risk of HCC and cirrhosis. The current study was undertaken to assess HDV genotype distribution and determine clinical characteristics of hepatitis delta virus (HDV) among HBsAg positive individuals in Shanghai. METHOD: This retrospective study involved 225 serum samples from HBsAg positive hospitalized patients from October 2010 to April 2013. HDV-specific RT-nested PCR was used to amplify HDV RNA. HDV genotypes were characterized by Next-generation sequencing (NGS), followed by phylogenetic analyses. HDV/HBV co-infected patients and HBV mono-infected patients were compared clinically and virologically. RESULTS: Out of the 225 HBsAg-positive serum samples with elevated transaminases, HDV-RNA was identified in 11 (4.9%) patients. The HBV loads in the HDV positive group were significantly lower than the HDV negative HBV-infected patients. The aminotransferase enzymes were significantly higher in HDV/HBV co-infected compared to HDV negative patients (P < 0.05). Phylogenetic analyses indicated that HDV-2 genotype being the predominant genotype, other HDV genotypes were not observed. HDV/HBV patients were significantly associated with a rather unfavourable clinical outcome. CONCLUSION: In summary, the prevalence of HDV infection in patients with elevated transaminases is not low and the predominance of HDV genotype 2 infection in Shanghai. This finding helps us to better understand the correlation of HDV/HBV co-infection. Moreover, Next-generation sequencing (NGS) technologies provide a rapid, precise method for generating HDV genomes to define infecting genotypes.


Assuntos
Hepatite D/diagnóstico , Vírus Delta da Hepatite/genética , Adulto , Sequência de Aminoácidos , China/epidemiologia , Coinfecção , Feminino , Genótipo , Hepatite B/diagnóstico , Hepatite B/virologia , Antígenos de Superfície da Hepatite B/sangue , Hepatite D/epidemiologia , Hepatite D/virologia , Vírus Delta da Hepatite/classificação , Vírus Delta da Hepatite/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Filogenia , Prevalência , RNA Viral/química , RNA Viral/metabolismo , Estudos Retrospectivos , Fatores de Risco , Carga Viral , Adulto Jovem
2.
Am J Trop Med Hyg ; 103(1): 169-174, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32431268

RESUMO

Hepatitis D virus (HDV) genotype III is endemic in the western Amazon basin and is considered to cause the most severe form of chronic viral hepatitis. Recently, noninvasive fibrosis scores to determine the stage of liver fibrosis have been evaluated in individuals positive for HDV genotype I, but their utility in HDV genotype III-positive patients is unknown. In this retrospective study conducted in an outpatient viral hepatitis referral clinic in the Brazilian Amazon region, the aspartate aminotransferase (AST) to Aspartate aminotransferase to Platelet Ratio Index (APRI) and Fibrosis Index for Liver Fibrosis (FIB-4) values were calculated and compared with histological fibrosis stages. Among the 50 patients analyzed, the median age at liver biopsy was 35.6 years, 66% were male, and all had compensated liver disease. Histological staging revealed fibrosis stages 0, 1, 2, 3, and 4 in four (8%), eight (16%), 11 (22), 11 (22%), and 16 (32%) patients, respectively. The area under the receiver operating curve (AUROC) of AST-to-alanine aminotransferase (ALT) ratio, APRI, and FIB-4 for detection of significant fibrosis (F ≥ 2) was 0.550 (P = 0.601), 0.853 (P < 0.001), and 0.853 (P < 0.0001), respectively. Lower AUROC values were obtained for cirrhosis: the AST-to-ALT ratio was 0.640 (P = 0.114), APRI was 0.671 (P = 0.053), and FIB-4 was 0.701 (P = 0.023). The optimal cutoff value for significant fibrosis for APRI was 0.708 (sensitivity 84% and specificity 92%) and for FIB-4 was 1.36 (sensitivity 76% and specificity 92%). Aspartate aminotransferase to Platelet Ratio Index and FIB-4 were less useful to predict cirrhosis. In contrast to recent reports from Europe and North America, both APRI and FIB-4 may identify significant fibrosis in HDV-III-infected patients from northwestern Brazil.


Assuntos
Vírus da Hepatite B/patogenicidade , Hepatite B/diagnóstico , Hepatite D/diagnóstico , Vírus Delta da Hepatite/patogenicidade , Cirrose Hepática/diagnóstico , Adulto , Alanina Transaminase/metabolismo , Área Sob a Curva , Aspartato Aminotransferases/metabolismo , Biomarcadores/análise , Plaquetas/patologia , Plaquetas/virologia , Brasil , Doença Crônica , Coinfecção , Feminino , Hepatite B/enzimologia , Hepatite B/patologia , Hepatite B/virologia , Hepatite D/enzimologia , Hepatite D/patologia , Hepatite D/virologia , Humanos , Cirrose Hepática/enzimologia , Cirrose Hepática/patologia , Cirrose Hepática/virologia , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Contagem de Plaquetas , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Índice de Gravidade de Doença
3.
Gastroenterol Clin North Am ; 49(2): 239-252, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32389361

RESUMO

Half a century after its discovery, hepatitis delta remains a pertinent global health issue with a major clinical impact in endemic regions and an underestimated prevalence worldwide. Hepatitis delta virus infection follows a challenging clinical course and is responsible for significant liver-related morbidity. Although the only currently available treatment (pegylated interferon) does not provide consistent results, emerging therapeutic options are promising. This article explores the epidemiology, natural history, as well as current and potential therapeutic options for hepatitis delta virus infection.


Assuntos
Hepatite D/diagnóstico , Hepatite D/terapia , Adenina/análogos & derivados , Adenina/uso terapêutico , Anticorpos Antivirais/sangue , Antivirais/uso terapêutico , Biomarcadores/sangue , Carcinoma Hepatocelular/etiologia , Saúde Global , Hepatite D/epidemiologia , Hepatite D/virologia , Vírus Delta da Hepatite/genética , Vírus Delta da Hepatite/imunologia , Antígenos da Hepatite delta/imunologia , Humanos , Interferon alfa-2/uso terapêutico , Lamivudina/uso terapêutico , Cirrose Hepática/etiologia , Neoplasias Hepáticas/etiologia , Transplante de Fígado , Organofosfonatos/uso terapêutico , Prevalência , RNA Viral , Risco , Testes Sorológicos/métodos
4.
Artigo em Inglês | MEDLINE | ID: mdl-32305262

RESUMO

Viral hepatitis can cause significant maternal and neonatal morbidity and mortality. Hepatitis A and E mainly present as acute hepatitis during pregnancy, while hepatitis C and D are usually found as chronic infection in pregnant women. Hepatitis A remains self-limiting during pregnancy while hepatitis E has a higher prevalence and manifests with a rigorous course in pregnant women. Screening of hepatitis C during pregnancy and its subsequent management during pregnancy are still a debatable topic. New treatments of hepatitis C and E require further evaluation for use in pregnancy. This review summarizes the prevalence, clinical manifestations, maternal, foetal and neonatal effects, and the management of hepatitis A, C, D and E viral infection during pregnancy.


Assuntos
Hepatite A/terapia , Hepatite C/terapia , Hepatite D/terapia , Hepatite E/terapia , Complicações Infecciosas na Gravidez/virologia , Feminino , Hepatite A/diagnóstico , Hepatite A/epidemiologia , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Hepatite D/diagnóstico , Hepatite D/epidemiologia , Hepatite E/diagnóstico , Hepatite E/epidemiologia , Humanos , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/terapia , Cuidado Pré-Natal , Prevalência
5.
Klin Lab Diagn ; 65(2): 95-99, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32159306

RESUMO

The aim of this study was to assess the rates of detection of the major markers of infection with hepatitis B and Delta (D) viruses in serum, saliva and dry blood dots (DBS) as a possible option for serological studies among the population of the endemic region in conditions of limited laboratory resources. For this purpose, paired samples of blood serum and DBS, blood serum and saliva from patients with chronic hepatitis B with Delta agent living in the Republic of Tyva, which is endemic for this disease. HBsAg was detected in 289 (100%) serum samples, in 88/92 (95.7%) saliva samples, in 60/80 (75%) DBS samples, stored three years at room temperature, and in 111/117 (94.9%) DBS stored one year at the same conditions. Anti-HBcore was detected in 209 (100%) serum samples, while in saliva and DBS samples this marker was detected in only 13.04% (12/92) and 19.7% (23/117), respectively. Anti-HDV antibodies in serum were detected in 209 (100%) samples collected from patients in 2017-2018. In saliva and DBS anti-HDV were not detected in any sample. This difference in the detection rates of anti-HBcore and anti-HDV might be accounted for the fact that the HBV core protein is a very strong immunogen, indusing the production of anti-HBcore in high concentrations. Probably, the concentration of anti-HDV is much lower, which explains its absence in saliva and DBS in patients with hepatitis B+D. Samples of biological media (saliva), as well as DBS can serve as an alternative material for the detection of HBsAg in screening and research prevalence studies. Meanwhile, the definition of anti-HDV in such media is not possible due to the false negative results. Due to the high probability of superinfection with HDV in patients with HBV in endemic areas, the detection of HBsAg in alternative media (saliva or DBS) should be followed by testing for anti-HDV in serum samples.


Assuntos
Teste em Amostras de Sangue Seco , Anticorpos Anti-Hepatite/análise , Antígenos de Superfície da Hepatite B/análise , Hepatite B/diagnóstico , Hepatite D/diagnóstico , Humanos , Federação Russa , Saliva/química
6.
Rev Med Suisse ; 15(666): 1802-1806, 2019 Oct 09.
Artigo em Francês | MEDLINE | ID: mdl-31599521

RESUMO

Discovered in 1977, Hepatitis D is the most severe form of chronic hepatitis, with rapid development of cirrhosis, hepatic failure and hepatocellular carcinoma. Despite all this, it is still largely underdiagnosed and there is no standardised management. The current treatment options are scarce and bear frequent side-effects, but the early diagnosis and an optimal follow-up with identification of the patients suitable for treatment improve significantly their survival rate and quality of life. Moreover, new promising treatments are entering phase III trials and offer new perspectives for our patients.


Assuntos
Hepatite D/terapia , Carcinoma Hepatocelular/virologia , Ensaios Clínicos Fase III como Assunto , Hepatite D/diagnóstico , Humanos , Cirrose Hepática/virologia , Neoplasias Hepáticas/virologia , Taxa de Sobrevida
7.
Diagn Microbiol Infect Dis ; 95(4): 114873, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31473034

RESUMO

Hepatitis B/D virus infection leads to severe liver disease. HDV infection is not routinely investigated since the diagnosis is based on enzyme immunoassays (EIAs), which are not available in all laboratories. This study investigates the performance of new automated assay for anti HDV Ab detection: LIAISON® XL Murex anti-HDV. HBsAg-positive samples were evaluated for HDV serology using the ETI-AB-DELTAK-2 and the new LIAISON® XL Murex with a concordance of 97.5% and 2.42% discordant results. The discordant specimens reacted negatively with EIA and positively with the new test. Dilutions of HDV-purified antibodies and HDV-positive samples were tested with both assays, showing a lower detection limit for the new assay. In conclusion, LIAISON® XL Murex showed a good concordance with the reference method and allowed a more rapid HDV detection. This new diagnostic tool may be useful for a more efficient approach to the HDV diagnosis and evaluation of HDV epidemiology.


Assuntos
Anticorpos Anti-Hepatite/sangue , Hepatite D/diagnóstico , Vírus Delta da Hepatite/imunologia , Vírus Delta da Hepatite/isolamento & purificação , Técnicas Imunoenzimáticas/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Automação Laboratorial , Feminino , Antígenos de Superfície da Hepatite B/sangue , Humanos , Técnicas Imunoenzimáticas/normas , Medições Luminescentes , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Testes Sorológicos , Adulto Jovem
8.
Mem Inst Oswaldo Cruz ; 114: e190074, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31460570

RESUMO

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.


Assuntos
Anticorpos Anti-Hepatite/sangue , Hepatite B Crônica/epidemiologia , Hepatite D/epidemiologia , Vírus Delta da Hepatite , RNA Viral/genética , Adolescente , Adulto , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Genótipo , Hepatite B Crônica/complicações , Hepatite D/complicações , Hepatite D/diagnóstico , Vírus Delta da Hepatite/genética , Vírus Delta da Hepatite/imunologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Filogenia , Prevalência , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Risco , Adulto Jovem
9.
J Med Virol ; 91(12): 2049-2058, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31429940

RESUMO

AIMS: Little data have been published so far on the epidemiological aspects of hepatitis D virus (HDV) infection in immigrant populations and even poorer is the information on the virological, phylogenetic, and clinical aspects of this infection in these populations. This review article, aimed primarily at physicians caring for immigrants, summarizes the information available on HDV infection and analyzes data on this topic concerning the immigrant populations. METHODS AND RESULTS: The prevalence of HDV infection in HBsAg-positive immigrants varies according to the country of origin. For example, in immigrants from sub-Saharan Africa, this prevalence is higher in those born in Equatorial Guinea (24.4%) than those from other African countries (10.3%). The epidemiological impact of HDV infection linked to migratory flows is a function of the different endemicity between countries of origin and countries in which a new existence has been established. This impact is high when immigrants from areas endemic to HDV infection (eg, Equatorial Guinea) settle in areas of low endemicity (eg, Germany or England, with a prevalence of around 4%), while the impact is lesser or nonexistent if the migratory flows are directed toward countries with intermediate endemicity (eg, Italy and Greece, with a prevalence of around 10%). CONCLUSION: This impact of immigration on HDV epidemiology can be strong when HDV endemicity is high in the country of origin and low in the host country and slight when immigrants move to high or medium endemic countries.


Assuntos
Doenças Transmissíveis Importadas/epidemiologia , Emigrantes e Imigrantes/estatística & dados numéricos , Hepatite D/diagnóstico , África/epidemiologia , Antivirais/uso terapêutico , Coinfecção/epidemiologia , Coinfecção/virologia , Doenças Transmissíveis Importadas/virologia , Guiné Equatorial/epidemiologia , Europa (Continente) , Hepatite D/tratamento farmacológico , Hepatite D/epidemiologia , Vírus Delta da Hepatite/classificação , Vírus Delta da Hepatite/efeitos dos fármacos , Vírus Delta da Hepatite/genética , Humanos , Filogenia , Prevalência
10.
BMC Res Notes ; 12(1): 417, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307546

RESUMO

OBJECTIVE: The aim of this study was to update the data on the prevalence of anti-HDV antibodies in Cameroon. RESULTS: Antibodies against hepatitis Delta virus (Anti-HDV) were found in 16.48% (95% CI 11.46-18.77%) of 426 hepatitis B virus surface antigen positive patients in Cameroon. Remarkably, they were significantly higher among people over 40 years and those living in the East and South regions of Cameroon at 66.7%, 50%, and 40%, respectively. These results suggest that older age and living in areas in the dense forest may be risk factors for Hepatitis D infection.


Assuntos
Anticorpos Anti-Hepatite/imunologia , Antígenos de Superfície da Hepatite B/imunologia , Hepatite B/diagnóstico , Hepatite D/diagnóstico , Vírus Delta da Hepatite/imunologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Evolução Biológica , Camarões/epidemiologia , Criança , Estudos Transversais , Feminino , Hepatite B/epidemiologia , Hepatite B/virologia , Hepatite D/epidemiologia , Hepatite D/virologia , Vírus Delta da Hepatite/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
11.
Gastroenterol Clin North Am ; 48(2): 259-279, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31046974

RESUMO

Many microbes, toxins, autoimmune diseases, and neoplastic diseases may cause liver inflammation; however, 5 viruses whose main pathogenesis is liver disease are referred to as hepatitis A, B, C, D, and E viruses. These viruses cause a significant burden of global illness. With the exception of hepatitis A virus, all may cause chronic infection potentially leading to cirrhosis and hepatocellular carcinoma. Excellent serologic and nucleic acid detection methods are available for determining the precise cause and, in some cases, the duration of infection. Diagnostics are critical for identifying individuals needing treatment and for monitoring the treatment success.


Assuntos
Técnicas de Laboratório Clínico , Hepatite B/diagnóstico , Hepatite C/diagnóstico , Hepatite D/diagnóstico , Técnicas de Laboratório Clínico/métodos , Humanos , Monitorização Fisiológica , Técnicas de Amplificação de Ácido Nucleico , Testes Sorológicos/métodos
13.
Tumori ; 105(6): NP72-NP74, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30935288

RESUMO

BACKGROUND: Cytotoxic and immunosuppressive therapies for cancer treatment may allow hepatitis reactivation. Hepatitis due to viral hepatitis reactivation is detected in 14%-25% of hepatitis B surface antigen (HBsAg)-positive cancer patients undergoing anticancer treatments. Drug toxicity may be confused with hepatitis reactivation, which may cause a delay in diagnosis. CASE REPORT: A 60-year-old man with metastatic renal cell carcinoma was treated with sunitinib. Sixteen months after sunitinib inception, liver enzymes were elevated and viral hepatitis reactivation was detected as hepatitis delta virus infection in the HBsAg-positive patient. CONCLUSION: Cancer patients should be screened for viral hepatitis prior to immunosuppressive therapy or chemotherapy.


Assuntos
Antineoplásicos/efeitos adversos , Carcinoma de Células Renais/complicações , Hepatite D/etiologia , Vírus Delta da Hepatite , Neoplasias Renais/complicações , Sunitinibe/efeitos adversos , Ativação Viral/efeitos dos fármacos , Antineoplásicos/uso terapêutico , Antivirais/uso terapêutico , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/tratamento farmacológico , Hepatite D/diagnóstico , Hepatite D/tratamento farmacológico , Vírus Delta da Hepatite/efeitos dos fármacos , Vírus Delta da Hepatite/fisiologia , Humanos , Neoplasias Renais/diagnóstico , Neoplasias Renais/tratamento farmacológico , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Sunitinibe/uso terapêutico , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
Dtsch Med Wochenschr ; 144(8): 528-534, 2019 04.
Artigo em Alemão | MEDLINE | ID: mdl-30986860

RESUMO

With approximately 240 million chronically infected people, hepatitis B virus (HBV) infection is a leading cause of cirrhosis and hepatocellular carcinoma in the world. Chronic HBV infection should be treated with antivirals, if either liver cirrhosis with detectable HBV DNA or relevant viral load (HBV DNA > 2000 IU/ml) and signs of liver damage (transaminase elevation, fibrosis, risk of liver cancer or similar) are present. The current standard therapy is a long-term treatment with nucleoside or nucleotide analogues such as entecavir, tenofovir disoproxil fumarate or tenofovir alafenamide, while in selected cases interferon treatment (for 48 weeks) may be useful. Entecavir and the new drug tenofovir alafenamide (TAF) are to be preferred over tenofovir disoproxil fumarate in patients with concomitant renal insufficiency or osteoporosis. Pregnant women with high viral load (> 200 000 IU/ml) should be treated with tenofovir in the third trimester to minimize the risk of neonatal transmission (in addition to immediate active-passive immunization). In conditions of immunosuppression (e. g. chemotherapy, rituximab, anti-TNF), even a "healed" HBV infection may reactivate in a life-threatening manner, requiring prophylactic antiviral therapy in addition to testing for HBV in high-risk situations. The current therapies primarily achieve virus suppression, but rarely the loss of HBs antigen, which is considered a functional cure. New strategies such as discontinuation of long-term antiviral therapy with provoked reactivation and also completely new drugs are currently in clinical trials. The most serious form of viral hepatitis is the co-/superinfection of HBV with the delta virus (HDV). Standard therapy for delta hepatitis is pegylated interferon-alfa, but the approval of new drugs such as the HBV entry inhibitor Myrcludex is expected in the near future.


Assuntos
Hepatite B Crônica/terapia , Hepatite D/terapia , Antivirais/uso terapêutico , Feminino , Hepatite B Crônica/diagnóstico , Hepatite B Crônica/epidemiologia , Hepatite D/diagnóstico , Hepatite D/epidemiologia , Humanos , Interferons/uso terapêutico , Nucleosídeos/uso terapêutico , Nucleotídeos/uso terapêutico , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/terapia , Fatores de Risco
16.
Antivir Ther ; 24(2): 117-123, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30516520

RESUMO

BACKGROUND: HDV infection is a cause of severe liver disease. Diagnosis and monitoring of HDV RNA are important to patient management. Since 2012, a WHO standard for HDV RNA quantification has been available; however, the impact of RNA extraction methods on HDV viral load quantification has never been evaluated. METHODS: The aim of this study was to compare four commonly used automated nucleic acid (NA) extraction methods (AmpliPrep, MagNA Pure, QIAcube QBK and QIAcube VRK) with a manual RNA extraction method (Instant Virus RNA/DNA kit) and evaluate the possible effect of each method on HDV RNA yield with subsequent amplification with the Robogene HDV assay. Serum samples from HDV-positive patients taken before treatment with pegylated interferon-α2a and at treatment weeks 12 and 48 were studied. RESULTS: The automated extraction methods MagNA Pure, Ampliprep and QIAcube VRK extraction led to about 10-fold lower HDV RNA values compared with the manual method of NA extraction, while the difference was smaller with QIAcube QBK (about 6-fold lower). The median viral load was 10,665 IU/ml for the manual method, 445 IU/ml for AmpliPrep, 3,209 IU/ml for MagNA Pure, 2,060 IU/ml for QIAcube QBK and 3,568 IU/ml for QIAcube VRK. Use of MagNA Pure led to misclassification of two on-treatment samples with low viral load as being false negative. CONCLUSIONS: The NA extraction method had a significant impact on the measured HDV viral loads determined by the commonly used Robogene assay, with the manual RNA method yielding consistently higher values of viral load. ClinicalTrials.gov Identifier: NCT00932971.


Assuntos
Hepatite D/diagnóstico , Hepatite D/virologia , Vírus Delta da Hepatite/genética , Ácidos Nucleicos/isolamento & purificação , Carga Viral/métodos , Automação Laboratorial , DNA Viral , Genótipo , Humanos , RNA Viral/isolamento & purificação , Kit de Reagentes para Diagnóstico , Reprodutibilidade dos Testes , Carga Viral/normas
18.
BMC Infect Dis ; 18(1): 516, 2018 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-30314448

RESUMO

BACKGROUND: Viral hepatitis is an important public health issue in sub-Saharan Africa. Due to rising mortality from cirrhosis and hepatocellular carcinoma and limited implementation of screening and treatment programmes, it has been characterised as a neglected tropical disease. Synthesis of the existing evidence on the epidemiology of viral hepatitis B, C and D in Malawi is required to inform policy and identify research gaps. METHODS: We searched Pubmed, EMBASE and Scopus for studies reporting the epidemiology of viral hepatitis B, C and D in Malawi from 1990 to 2018. Articles reporting prevalence estimates were included provided they described details of participant selection, inclusion criteria and laboratory methods (detection of HBsAg, anti-HCV or anti-HDV antibody, HCV antigen or HCV RNA or HDV RNA). We assessed study quality using a prevalence assessment tool. Where appropriate, a pooled prevalence was calculated using a DerSimonian Laird random effects model. RESULTS: Searches identified 199 studies, 95 full text articles were reviewed and 19 articles were included. Hepatitis B surface antigen (HBsAg) seroprevalence was assessed in 14 general population cohorts. The pooled prevalence among adults was 8.1% (95% CI 6.1, 10.3). In 3 studies where HBsAg was stratified by HIV status, no effect of HIV on HBsAg prevalence was observed (OR 1.2 (95% CI: 0.8, 1.6, p = 0.80)). In a single study of HIV/HBV infected individuals, anti-hepatitis D antibody (anti-HDV) prevalence was low (1.5%). HCV antibody prevalence (anti-HCV) ranged from 0.7 to 18.0% among 12 cohorts in general populations. Among three studies which used PCR to confirm current infection, the pooled rate of HCV RNA confirmation among anti-HCV positive individuals was only 7.3% (95% CI: 0.0, 24.3). CONCLUSIONS: Hepatitis B is highly prevalent in Malawi. There is a paucity of epidemiological data from rural areas where 85% of the population reside, and the Northern region. Priority research needs include large-scale representative community studies of HBV, HDV and HCV seroprevalence, assessment of children following introduction of the HBV vaccine in 2002, prevalence estimates of viral hepatitis among individuals with cirrhosis and HCC and data on HCV prevalence using PCR confirmation, to support a viral hepatitis strategy for Malawi.


Assuntos
Hepatite B/epidemiologia , Hepatite C/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Anticorpos Anti-Hepatite/sangue , Hepatite B/complicações , Hepatite B/diagnóstico , Antígenos de Superfície da Hepatite B/sangue , Hepatite C/complicações , Hepatite C/diagnóstico , Hepatite D/complicações , Hepatite D/diagnóstico , Hepatite D/epidemiologia , Humanos , Malaui/epidemiologia , Prevalência , RNA Viral/sangue , RNA Viral/metabolismo
19.
ScientificWorldJournal ; 2018: 9312650, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30356409

RESUMO

Background: Hepatitis D virus (HDV) infection has been considered a serious neglected pandemic, particularly in developing countries. The virus causes a more severe disease than mono infection with hepatitis B virus (HBV). The epidemiology of HDV is not well documented in North Africa, which is known to be endemic for HBV. In this study, we explored the prevalence of HDV infection and also attempted to identify factors associated with hepatitis D positive status among chronic hepatitis B patients in North Africa. Methods: The electronic databases PubMed, Embase, Scopus, Science Direct, Web of Science, and Google Scholar were comprehensively searched for all papers published between January 1, 1998, and December 31, 2017, using appropriate strategies containing all related keywords, including North Africa, names of countries in the region, and all permutations of hepatitis D virus. The estimated prevalence of HDV in North Africa was calculated as an average of the pooled infection prevalence in each country weighted by the ratio of the country's hepatitis D virus population to the study's sample size in the survey data analysis. Findings: A total of 312 studies were identified and 32 were included in this study, with a total sample of 4907 individuals screened for HDV. There was considerable variability in the prevalence estimates of HDV within the countries of the region. The overall prevalence of HDV in the general population of North Africa was 5·01% (95% CI: 1·25-8·27) and in liver disease patients it was 20.7% (95% CI:9.87-44.53). Genotype-1 was the most prominent genotype reported in five published studies. Ten studies reported on HDV RNA in participants who were seropositive for HDV, and four studies highlighted the impact of demographic factors (sex and age). No study showed the impact of risk factors on the prevalence of HDV in North Africa. Interpretation: This review provides a comprehensive assessment of the burden of HDV in Northern Africa. There were significant differences in seroprevalence, study population, and diagnostic testing between the countries in the region. The results presented here will alert health professionals to implement clear policies based on evidence to diminish the burden of HDV infection. Such measures may include but are not restricted to improving the laboratory diagnostic tests and initiating patient data registries and blood screening. Further epidemiological and research studies are needed to explore the risk factors, coinfections, and approaches to increase testing for HDV, particularly in high-risk subpopulations, such as intravenous drug users and immigrants, and to define the consequences of HDV infection in North Africa.


Assuntos
Efeitos Psicossociais da Doença , Hepatite D/epidemiologia , Vírus Delta da Hepatite/isolamento & purificação , África do Norte/epidemiologia , Bases de Dados Factuais/tendências , Emigração e Imigração/tendências , Hepatite D/sangue , Hepatite D/diagnóstico , Vírus Delta da Hepatite/metabolismo , Humanos , Abuso de Substâncias por Via Intravenosa/sangue , Abuso de Substâncias por Via Intravenosa/diagnóstico , Abuso de Substâncias por Via Intravenosa/epidemiologia
20.
Eur J Gastroenterol Hepatol ; 30(9): 1063-1065, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29927770

RESUMO

BACKGROUND: The hepatitis delta virus (HDV) causes the most aggressive form of chronic viral hepatitis. As HDV replication requires hepatitis B virus (HBV), HDV screening is limited to HBsAg+ carriers. To date, individuals with HDV-antibodies and markers of resolved hepatitis B are considered cured. However, a subset shows elevated liver enzymes and hepatic fibrosis. Could they represent HBsAg-seronegative occult HDV infections? METHODS: We tested for HDV-antibodies 406 individuals with markers of past HBV exposure. RESULTS: Overall, 20 (4.9%) were reactive for HDV-antibodies. All were negative for serum HDV-RNA, including four with elevated liver enzymes. CONCLUSION: These results support the current policy of screening for hepatitis delta only in HBsAg+ individuals.


Assuntos
Coinfecção , Hepatite B/diagnóstico , Hepatite D/diagnóstico , Adulto , Idoso , Alanina Transaminase/sangue , Antivirais/uso terapêutico , Aspartato Aminotransferases/sangue , Tomada de Decisão Clínica , Feminino , Anticorpos Anti-Hepatite/sangue , Hepatite B/sangue , Hepatite B/tratamento farmacológico , Antígenos de Superfície da Hepatite B/sangue , Hepatite D/sangue , Vírus Delta da Hepatite/genética , Vírus Delta da Hepatite/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , RNA Viral/sangue , RNA Viral/genética
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