Prevalence of hepatitis D virus infection in Central Italy has remained stable across the last 2 decades with dominance of subgenotypes 1 and characterized by elevated viral replication
oleh: Romina Salpini, Lorenzo Piermatteo, Giulia Torre, Stefano D'Anna, Sohaib Khan, Leonardo Duca, Ada Bertoli, Simone La Frazia, Vincenzo Malagnino, Elisabetta Teti, Marco Iannetta, Pierpaolo Paba, Marco Ciotti, Ilaria Lenci, Simona Francioso, Caterina Paquazzi, Miriam Lichtner, Claudio Mastroianni, Francesco Santopaolo, Giuseppe De Sanctis, Adriano Pellicelli, Giovanni Galati, Alessandra Moretti, Katia Casinelli, Luciano Caterini, Nerio Iapadre, Giustino Parruti, Iacopo Vecchiet, Maurizio Paoloni, Massimo Marignani, Francesca Ceccherini-Silberstein, Leonardo Baiocchi, Sandro Grelli, Loredana Sarmati, Valentina Svicher
| Format: | Article |
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| Diterbitkan: | Elsevier 2024-01-01 |
Deskripsi
Objectives: Here we investigate Hepatitis D virus (HDV)-prevalence in Italy and its fluctuations over time and we provide an extensive characterization of HDV-infected patients. Methods: The rate of HDV seroprevalence and HDV chronicity was assessed in 1579 hepatitis B surface antigen (HBsAg)+ patients collected from 2005 to 2022 in Central Italy. Results: In total, 45.3% of HBsAg+ patients received HDV screening with an increasing temporal trend: 15.6% (2005-2010), 45.0% (2011-2014), 49.4% (2015-2018), 71.8% (2019-2022). By multivariable model, factors correlated with the lack of HDV screening were alanine-aminotransferase (ALT) less than two times of upper limit of normality (<2ULN) and previous time windows (P <0.002). Furthermore, 13.4% of HDV-screened patients resulted anti-HDV+ with a stable temporal trend. Among them, 80.8% had detectable HDV-ribonucleic acid (RNA) (median [IQR]:4.6 [3.6-5.6] log copies/ml) with altered ALT in 89.3% (median [IQR]:92 [62-177] U/L).Anti-HDV+ patients from Eastern/South-eastern Europe were younger than Italians (44 [37-54] vs 53 [47-62] years, P <0.0001), less frequently nucleos(t)ide analogs (NUC)-treated (58.5% vs 80%, P = 0.026) with higher HDV-RNA (4.8 [3.6-5.8] vs 3.9 [1.4-4.9] log copies/ml, P = 0.016) and HBsAg (9461 [4159-24,532] vs 4447 [737-13,336] IU/ml, P = 0.032). Phylogenetic analysis revealed the circulation of HDV subgenotype 1e (47.4%) and -1c (52.6%). Notably, subgenotype 1e correlated with higher ALT than 1c (168 [89-190] vs 58 [54-88] U/l, P = 0.015) despite comparable HDV-RNA. Conclusions: HDV-screening awareness is increasing over time even if some gaps persist to achieve HDV screening in all HBsAg+ patients. HDV prevalence in tertiary care centers tend to scarcely decline in native/non-native patients. Detection of subgenotypes, triggering variable inflammatory stimuli, supports the need to expand HDV molecular characterization.