In China, the endemic nature of Hepatitis B Virus (HBV) and the challenges posed by Human Immunodeficiency Virus (HIV-1) co-infections have been sources of significant public health concern. In a groundbreaking study featured in the International Journal of Infectious Diseases, researchers set out to investigate the prevalence and molecular traits of Hepatitis Delta Virus (HDV), a satellite virus that can only propagate in the presence of HBV, to gain insights into its spread across the country. The study’s findings disclose a pressing situation that speaks to the need for strategic interventions in managing HDV co-infections in China.

Published on January 11, 2024, with a DOI of 10.1016/j.ijid.2023.12.014, the paper is authored by a team of notable scholars, including Wang Yan from the National Clinical Research Center for Geriatric Diseases, and Zhang Fujie, known for his work at the Clinical and Research Center for Infectious Diseases in Beijing. This collaborative research brought together data from 13 representative sites across the northern, southern, western, and southwestern regions of China, offering a detailed understanding of the HDV epidemic in a diverse and vast national landscape.

The extensive study examined a total of 3,000 samples, inclusive of 2,241 HBV monoinfections and 759 HBV/HIV-1 coinfections, to address the prevalence of HDV among these populations. Employing serological and virological methods to detect anti-HDV antibodies and HDV RNA, the researchers sought to paint a comprehensive picture of the current HDV landscape.

Regarding the seroprevalence of HDV, the study revealed that 2.63% (95% CI: 2.06-3.21) of the HBV-infected population in China tested positive for anti-HDV antibodies, indicating a previous or ongoing HDV infection. Nevertheless, this seroprevalence demonstrated notable regional variation, hinting at differing risks and transmission dynamics across the country. Perhaps even more striking was the finding among HBV and HIV-1 coinfections, where HDV seroprevalence soared to 7.91% (95% CI: 5.98-9.83), shedding light on the vulnerability of individuals suffering from dual infections.

As for virological prevalence, the results showed that 0.67% (95% CI: 0.38-0.96) of HBV infections and 2.24% (95% CI: 1.18-3.29) of HBV/HIV-1 coinfections were HDV RNA positive. These indicators elucidate active HDV replication within these patient populations, which is a serious concern for clinicians and policymakers alike.

Molecular characterization pointed to HDV-2a as the predominant genotype in China, followed closely by HDV-1. The genotypic distribution is critical for guiding clinical decision-making since differences in HDV genotypes can influence disease progression and treatment responses.

The study’s authors unearthed a worrying correlation between anti-HDV positivity and health deterioration. Participants with HDV exposure had significantly higher rates of abnormal liver function tests and elevated HBV DNA loads (P< 0.001) compared to those without HDV, emphasizing the pathological impact of HDV co-infection.

This investigative work exposes the need for a targeted approach to tackle HDV in China, especially among high-risk populations. The authors flag the importance of enhanced screening, especially in regions with higher identified prevalence, and among individuals with HBV/HIV-1 coinfections. Given these compelling findings, the research holds the potential to reform public health strategies and initiatives aimed at reducing the affliction of liver diseases in China.

The article concludes with a call for action, urging that policymakers, healthcare providers, and researchers converge their efforts to implement integrated screening, vaccination, and patient education programs. This collaborative approach could mitigate the impact of HDV infections and coinfections with HBV and HIV-1.

The gravity of the findings within this expansive survey bolsters the pressing need for immediate and strategic public health measures. As HDV infection often leads to more severe liver disease including cirrhosis and hepatocellular carcinoma, the stakes are undeniably high.

Copyright © 2024 by Elsevier Ltd. The study, with its scope and depth, exemplifies the value of epidemiological research in responding to infectious disease challenges. The strategically selected cohort and methodology offer a clarified lens through which to view an otherwise murky and under-researched aspect of viral hepatitis.

For readers and practitioners seeking to access the complete study, the reference to this groundbreaking work is as follows:

Wang Yan, Shen Guizhou, Lu Ruichao, Liu Jun, Zhang Feng, Wang Hui, Cai Weiping, Zhang Fujie, (2024). The prevalence of HDV among HBsAg-positive populations with and without HIV-1 in China. Int J Infect Dis. DOI: 10.1016/j.ijid.2023.12.014.

Additionally, the research supports a proactive role in the assessment of HDV infection among those already battling HBV, underscoring the need for comprehensive care protocols that factor in the dual-threat these viruses represent when conjoined.

As the world grapples with various infectious diseases, the article serves as a critical reminder of the impact of co-infections and the intricacies involved in their management. The work lays a foundation for further studies and a more amplified global response to HDV, a pathogen that continues to lurk in the shadows of its more notorious counterparts, HBV and HIV.

Keywords

1. HDV prevalence in China
2. HBV and HIV coinfection
3. HDV genotypes HDV-2a HDV-1
4. Hepatitis B Virus Epidemic
5. Liver dysfunction and HDV

References

1. Wang Yan et al. The prevalence of HDV among HBsAg-positive populations with and without HIV-1 in China. Int J Infect Dis. 2024 Jan 11; DOI:10.1016/j.ijid.2023.12.014.
2. Hughes, S.A., Wedemeyer, H., & Harrison, P.M. (2011). Hepatitis delta virus. Lancet, 378(9785), 73-85.
3. Rizzetto, M., Canese, M.G., Aricò, S., Crivelli, O., Trepo, C., Bonino, F., & Verme, G. (1977). Immunofluorescence Detection of New Antigen-antibody System (δ/anti-δ) Associated to Hepatitis B Virus in Liver and in Serum of HbsAg Carriers. Gut, 18(12), 997-1003.
4. Farci, P., & Purcell, R.H. (2000). Clinical significance of hepatitis C virus genotypes and quasispecies. Seminars in Liver Disease, 20(1), 103-126.
5. Rizzetto, M. (2009). Hepatitis D: thirty years after. Journal of Hepatology, 50(5), 1043-1050.