January 11, 2019
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42% of adults with HBV are coinfected with HDV, study finds

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Eshan U. Patel, MPH
Eshan U. Patel

In the United States, 42% of adults with hepatitis B virus are coinfected with hepatitis D, suggesting a need for routine HDV testing among people with HBV, according to study findings.

Eshan U. Patel, MPH, and colleagues from Johns Hopkins University said the results of their study suggest that the prevalence of HDV in the U.S. is “significantly higher” than previously acknowledged.

According to Patel and colleagues, the American Association for the Study of Liver Diseases recommends that patients who are positive for hepatitis B surface antigen (HBsAg) and at high-risk for HDV infection also be tested for the presence of HDV antibodies.

“Given that a high percentage of HBsAg-positive individuals in the study had antibodies to HDV, clinicians should consider routine HDV antibody testing for all HBsAg-positive patients,” Patel told Infectious Disease News. “Clinicians should also recommend vaccination against HBV infection to patients in all recommended populations to help prevent HBV and HDV transmission.”

Infographic about HBV seroprevalence among adults with HIV 
Click to enlarge.

Patel noted that most people living with HBV are unaware of their infection, and that efforts are needed increase screening.

Screening patients for HBV susceptibility or infection, then vaccinating or treating them appropriately, was recently found to be cost effective, according to study findings published in Open Forum Infectious Diseases.

Unlike HBV, HDV is not a nationally notifiable infection and commercial RNA assays are not widely available, according to Patel and colleagues. For their study, they estimated the prevalence of ongoing HBV infections and seroprevalence of HDV infections in the U.S. using population-based data from the National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey conducted by the National Center for Health Statistics on a continuous basis. Patel and colleagues used pooled data collected from 21,832 NHANES respondents with complete data on demographic characteristics from 2011 to 2016.

According to the study findings, the prevalence of HBsAg among the total population aged 6 years or older was 0.28%. Of these, the prevalence of antibodies to HDV was 0.11%. When Patel and colleagues assessed only adults aged 18 years or older, they found a prevalence of 0.36% for HBsAg and 0.15% for antibodies to HDV. The highest prevalence of HBsAg and HDV was observed among Asian and foreign-born adults.

All adults who were positive for HDV were also HBsAg positive, Patel and colleagues noted. According to the study, 42% of the 113 HBsAg-positive adults were positive for HDV, with a 33% prevalence rate among HBsAg-positive U.S.-born adults and 46% among HBsAg-positive foreign-born adults. Among Asian HBsAg-positive adults, HDV prevalence was 45% compared with 39% of adults of all other races and identities.

Patel and colleagues also found that HBV/HDV coinfected adults had higher serological markers associated with liver disease, especially compared with uninfected adults. Among HBsAg-positive adults, 30% (95% CI, 17%-46%) of individuals also positive for HDV reported a liver disease diagnosis compared with 9% (95% CI, 5%-16%) of those who were negative for HDV antibodies.

Between 2013 and 2016, NHANES included a question inquiring if the respondent was ever diagnosed with hepatitis B. They found that only 33% (95% CI, 18%-51%) of HBsAg-positive adults were aware of their infection. Among HBsAg-positive adults with HDV antibodies, awareness of HBV infection was 47% (95% CI, 27%-68%) compared with 15% (95% CI, 6%-32%) among HBsAg-positive adults without HDV, according to the study.

Although it was not evaluated in this study, Patel said that patients with HBV/HDV coinfection have worse clinical outcomes compared with HBV-monoinfected patients. – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.