COINFECTION OF HBV AND HDV IN YAOUNDE

Chavely Gwladys Monamele (monamele.chavely@yahoo.fr)
Internal medicine, University of Yaounde I
June, 2013
 

Abstract

Background:
Hepatitis B virus (HBV) is a major global public health problem. More than 2 billion people are infected worldwide with a mortality rate of over 1 million people annually. Approximately 5% of these HBV carriers have hepatitis Delta virus (HDV) superinfection. Individuals with HBV/HDV co-infection often have a more severe evolution with a higher risk of cirrhosis and hepatocellular carcinoma (HCC). Chronic HBV is common in Cameroon with an estimated 10% prevalence. However, few data are available in our country on HBV/HDV co-infection.
Objective:
This study aimed at determining the seroprevalence of HDV as well as the virological and clinical characteristics of HBV mono-infected and HDV co-infected patients in Yaoundé.
Method:
It was a descriptive and cross-sectional study carried out in three hospitals in Yaoundé. We included into this study naïve HBV infected patients free of HIV and HCV infection based on their medical reports from August 2012 to January 2013. Once included a blood sample was collected from each patient for the search of anti-HDV, anti-HCV and anti-HIV antibodies. The samples collected were then screened for these viruses according to laboratory procedures.
Moreover, previously performed ultrasound and liver histological data were collected.
The data were analysed using SPSS statistical software version 18.0. Chi-square test and Fisher’s exact test were used to compare qualitative variables while the Student t test was used to compare quantitative variables.
Results:
The population comprised 128 chronic HBV infected patients of which 77 (60.2%) were male and 51 (39.8%) were female. The mean age was 33.02 ± 8.56 years and the most represented age group was 31-40 years.
HDV positive patients represented 32.8% of our population and HBeAg was present in 10.9% of the patients. Majority of the patients (66.4%) had low HBV DNA levels (< 2000 IU/ml). The most represented stage of HBV disease observed in our population was low replicative hepatitis (61.7%) while chronic active hepatitis was found in 31.3% of the patients.
Among 88 patients who did their ultrasound exam, 83% had a normal liver, 8% had liver cirrhosis and 9% had liver tumour.
Among the 60 patients with an assessment of liver fibrosis by biopsy and / or Fibrotest®-Actitest®, 46.7% showed no liver inflammation and no fibrosis, 26.6% of patients had moderate to severe necrotic activity and 45% had fibrosis stage ranging from moderate to cirrhosis.
In HBV/HDV co-infection (32.8%), mean viral load for HBV were significantly low in this group as compared to patients with HBV mono-infection (p-value: 0.016). These patients presented with higher liver cytolysis as compared to HBV mono-infected patients but the difference was not significant.
Chronic active hepatitis was significantly more prevalent in HBV/HDV co-infected patients (47.6%) as compared to HBV mono-infected patients (23.2%).
Conclusion:
The main findings of this study were the high prevalence of HDV among our study population, the suppression of HBV replication among HDV co-infected patients and the increased severity of liver disease observed in these patients with HBV/HDV co-infection. Large scale longitudinal studies are recommended in order to draw definitive conclusions.


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