Osiowy Carla, Swidinsky Ken, Haylock-Jacobs Sarah, Sadler Matthew D, Fung Scott, Wong David, Minuk Gerald Y, Doucette Karen E, Wong Philip, Tam Edward, Cooper Curtis, Ramji Alnoor, Ma Mang, Nudo Carmine, Tsoi Keith, Coffin Carla S
National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada.
University of Manitoba, Winnipeg, MB, Canada.
JHEP Rep. 2022 Feb 22;4(5):100461. doi: 10.1016/j.jhepr.2022.100461. eCollection 2022 May.
BACKGROUND & AIMS: HDV affects 4.5-13% of chronic hepatitis B (CHB) patients globally, yet the prevalence of HDV infection in Canada is unknown. To investigate the prevalence, genotype, demographics, and clinical characteristics of HDV in Canada, we conducted a retrospective analysis of (1) HDV antibody and RNA positivity among referred specimens, and (2) a cross-sectional subset study of 135 HDV seropositive +/-RNA (HDV+) patients compared with 5,132 HBV mono-infected patients in the Canadian HBV Network.
Anti-HDV IgG-positive specimens collected between 2012 and 2019 were RNA tested and the genotype determined. Patients enrolled in the Canadian HBV Network were >18 years of age and HBsAg-positive. Clinical data collected included risk factors, demographics, comorbidities, treatment, fibrosis assessment, and hepatic complications.
Of the referred patients, 338/7,080 (4.8%, 95% CI 4.3-5.3) were HDV seropositive, with 219/338 RNA-positive (64.8%, 95% CI 59.6-69.7). The HDV+ cohort were more likely to be born in Canada, to be White or Black/African/Caribbean than Asian, and reporting high-risk behaviours, compared with HBV mono-infected patients. Cirrhosis, complications of end-stage liver disease, and liver transplantation were significantly more frequent in the HDV+ cohort. HDV viraemia was significantly associated with elevated liver transaminases and cirrhosis. Five HDV genotypes were observed among referred patients but no association between genotype and clinical outcome was detected within the HDV+ cohort.
Nearly 5% of the Canadian HBV referral population is HDV seropositive. HDV infection is highly associated with risk behaviours and both domestic and foreign-born patients with CHB. HDV was significantly associated with progressive liver disease highlighting the need for increased screening and surveillance of HDV in Canada.
Evidence of HDV infection was observed in approximately 5% of Canadians who were infected with HBV referred to medical specialists. HDV-positive patients were more likely to be male, born in Canada, or White or Black/African/Caribbean compared to Asian, and to have reported high-risk activities such as injection or intranasal drug use or high-risk sexual contact compared with patients infected with only HBV. Patients infected with HDV were also more likely to suffer severe liver disease, including liver cancer, compared with HBV mono-infected patients.
全球范围内，丁型肝炎病毒（HDV）感染了4.5%-13%的慢性乙型肝炎（CHB）患者，但加拿大HDV感染的患病率尚不清楚。为了调查加拿大HDV的患病率、基因型、人口统计学特征和临床特征，我们对以下两项研究进行了回顾性分析：（1）送检标本中HDV抗体和RNA的阳性情况；（2）在加拿大HBV网络中，对135例HDV血清学阳性和/或RNA阳性（HDV+）患者与5132例单纯HBV感染患者进行的横断面亚组研究。
对2012年至2019年期间收集的抗-HDV IgG阳性标本进行RNA检测并确定基因型。纳入加拿大HBV网络的患者年龄>18岁且HBsAg阳性。收集的临床数据包括危险因素、人口统计学特征、合并症、治疗情况、纤维化评估和肝脏并发症。
在送检患者中，338/7080（4.8%，95%CI 4.3-5.3）为HDV血清学阳性，其中219/338例RNA阳性（64.8%，95%CI 59.6-69.7）。与单纯HBV感染患者相比，HDV+队列中的患者更有可能出生在加拿大，为白人或黑人/非洲人/加勒比人而非亚洲人，并且报告有高危行为。HDV+队列中肝硬化、终末期肝病并发症和肝移植更为常见。HDV病毒血症与肝转氨酶升高和肝硬化显著相关。在送检患者中观察到5种HDV基因型，但在HDV+队列中未检测到基因型与临床结局之间的关联。
在加拿大HBV转诊人群中，近5%的人HDV血清学阳性。HDV感染与高危行为以及国内外出生的CHB患者高度相关。HDV与进展性肝病显著相关，这突出表明加拿大需要加强对HDV的筛查和监测。
在转诊至医学专家处的感染HBV的加拿大人中，约5%存在HDV感染的证据。与仅感染HBV的患者相比，HDV阳性患者更有可能为男性，出生在加拿大，为白人或黑人/非洲人/加勒比人而非亚洲人，并且报告有注射或鼻内吸毒或高危性接触等高风险活动。与单纯HBV感染患者相比，感染HDV的患者也更有可能患严重肝病，包括肝癌。
