Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
Département d'Hépatologie, AP-HP, Hôpital Cochin, Paris, France.
Liver Int. 2022 Jan;42(1):249-252. doi: 10.1111/liv.15106. Epub 2021 Dec 7.
Novel treatments for hepatitis Delta virus (HDV) infection provide promising opportunities to treat patients with hepatitis B virus (HBV) and HDV co-infection. However, current clinical trials on HDV treatment rarely explore patients' barriers to treatments. In Europe, HDV infection mostly affects young migrants from HDV-endemic areas who experience early liver-related mortality. Migrants are more likely to face multiple situations of statutory and socioeconomic insecurity and structural barriers than non-migrants. These obstacles may impact their quality of life and can (i) lead them to give secondary importance to certain HDV care options, (ii) delay treatment initiation and (iii) affect their adherence and commitment to care. Preliminary results from the ANRS CO22 HEPATHER cohort show that the majority (61.6%) of HBV-HDV co-infected migrants live in poverty. Moreover, half were diagnosed and a quarter of those who initiated HBV treatment had been in France for no more than two years, a period when language skills are often still poor and when knowledge of the health and administrative system may be lacking. We advocate for increased social science research, in particular qualitative studies, to investigate the effects that multiple forms of precarity (weak access to social rights, language barriers, housing insecurity, unexpected expenditures and other difficulties) may have on HDV screening opportunities, follow-up, and treatment pathways in migrants. This will help adapt communication and care around viral hepatitis, as well as inform and orient medical services and public health actors about the difficulties that migrants encounter.
新型治疗乙型肝炎病毒 (HBV) 和丁型肝炎病毒 (HDV) 合并感染的方法为治疗此类患者提供了有前景的机会。然而，目前针对 HDV 治疗的临床试验很少探索患者治疗的障碍。在欧洲，HDV 感染主要影响来自 HDV 流行地区的年轻移民，这些人会出现早期与肝脏相关的死亡。移民比非移民更有可能面临多种法定和社会经济不安全以及结构性障碍的情况。这些障碍可能会影响他们的生活质量，并可能导致以下情况：(i) 他们对某些 HDV 护理选择的重视程度降低；(ii) 治疗启动延迟；(iii) 影响他们对治疗的坚持和承诺。ANRS CO22 HEPATHER 队列的初步研究结果表明，大多数 (61.6%) 乙型肝炎病毒-丁型肝炎病毒合并感染的移民生活贫困。此外，有一半人被诊断出患有该疾病，其中四分之一的人开始接受 HBV 治疗的时间不超过两年，在此期间，他们的语言技能往往仍较差，并且对卫生和行政系统的了解可能不足。我们提倡进行更多的社会科学研究，特别是定性研究，以调查多种形式的脆弱性（社会权利获取困难、语言障碍、住房不安全、意外支出和其他困难）对移民中 HDV 筛查机会、随访和治疗途径的影响。这将有助于调整针对病毒性肝炎的沟通和护理，并为医疗服务和公共卫生机构提供有关移民所面临困难的信息和指导。
