Kate El Bouzidi1, Wael Elamin2, Katharina Kranzer3, Dianne N Irish4, Bridget Ferns3, Patrick Kennedy5, William Rosenberg6, Geoffrey Dusheiko6, Caroline A Sabin7, Belinda C Smith8, Eleni Nastouli9. 1. University College London Hospitals NHS Foundation Trust, Department of Clinical Microbiology and Virology, 2nd Floor, 307 Euston Road, London NW1 3AD, UK. Electronic address: kate.elbouzidi@nhs.net. 2. Barts Health NHS Trust, Division of Infection, Pharmacy and Pathology Building, 80 Newark Street, London E1 2ES, UK. 3. University College London Hospitals NHS Foundation Trust, Department of Clinical Microbiology and Virology, 2nd Floor, 307 Euston Road, London NW1 3AD, UK. 4. Royal Free London NHS Foundation Trust, Department of Virology, Royal Free Hospital, Pond Street, London NW3 2QG, UK. 5. Barts Health NHS Trust, Department of Hepatology, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK. 6. UCL Institute for Liver and Digestive Health, Royal Free Hospital, Pond Street, London NW3 2QG, UK. 7. UCL Research Department of Infection and Population Health Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK. 8. Imperial College Healthcare NHS Trust, Hepatology Research Unit, St. Mary's Hospital, Praed Street, London W2 1NY, UK. 9. University College London Hospitals NHS Foundation Trust, Department of Clinical Microbiology and Virology, 2nd Floor, 307 Euston Road, London NW1 3AD, UK. Electronic address: e.nastouli@ucl.ac.uk.
Abstract
BACKGROUND: Hepatitis delta virus (HDV) testing is recommended for all patients with hepatitis B virus (HBV) infection. HDV infection is associated with severe liver disease and interferon is the only available treatment. OBJECTIVES: To determine the rate of anti-HDV antibody testing in HBV patients; and to describe the epidemiology, clinical characteristics and management of HDV-infected patients at four hospitals in London. STUDY DESIGN: The anti-HDV testing rate was estimated by reviewing clinical and laboratory data. Cross-sectional data collection identified HDV-infected patients who had attended the study centres between 2005 and 2012. RESULTS: At a centre with clinic-led anti-HDV testing, 40% (67/168) of HBV patients were tested. Recently diagnosed HBV patients were more likely to be screened than those under long-term follow-up (62% vs 36%, P=0.01). At a centre with reflex laboratory testing, 99.4% (3543/3563) of first hepatitis B surface antigen positive samples were tested for anti-HDV. Across the four study centres there were 55 HDV-infected patients, of whom 50 (91%) had immigrated to the UK and 27 (49%) had evidence of cirrhosis. 31 patients received interferon therapy for HDV with an end of treatment virological response observed in 10 (32%). CONCLUSIONS: The anti-HDV testing rate was low in a centre with clinic-led testing, but could not be evaluated in all centres. The HDV-infected patients were of diverse ethnicity, with extensive histological evidence of liver disease and poor therapeutic responses. Future recommendations include reflex laboratory testing algorithms and a prospective cohort study to optimise the investigation and management of these patients.
BACKGROUND:Hepatitis delta virus (HDV) testing is recommended for all patients with hepatitis B virus (HBV) infection. HDV infection is associated with severe liver disease and interferon is the only available treatment. OBJECTIVES: To determine the rate of anti-HDV antibody testing in HBVpatients; and to describe the epidemiology, clinical characteristics and management of HDV-infectedpatients at four hospitals in London. STUDY DESIGN: The anti-HDV testing rate was estimated by reviewing clinical and laboratory data. Cross-sectional data collection identified HDV-infectedpatients who had attended the study centres between 2005 and 2012. RESULTS: At a centre with clinic-led anti-HDV testing, 40% (67/168) of HBVpatients were tested. Recently diagnosed HBVpatients were more likely to be screened than those under long-term follow-up (62% vs 36%, P=0.01). At a centre with reflex laboratory testing, 99.4% (3543/3563) of first hepatitis B surface antigen positive samples were tested for anti-HDV. Across the four study centres there were 55 HDV-infectedpatients, of whom 50 (91%) had immigrated to the UK and 27 (49%) had evidence of cirrhosis. 31 patients received interferon therapy for HDV with an end of treatment virological response observed in 10 (32%). CONCLUSIONS: The anti-HDV testing rate was low in a centre with clinic-led testing, but could not be evaluated in all centres. The HDV-infectedpatients were of diverse ethnicity, with extensive histological evidence of liver disease and poor therapeutic responses. Future recommendations include reflex laboratory testing algorithms and a prospective cohort study to optimise the investigation and management of these patients.
Authors: Henry N Luma; Servais A F B Eloumou; Cécile Okalla; Olivier Donfack-Sontsa; Ruth Koumitana; Agnes Malongue; Georges B Nko'Ayissi; Dominique N Noah Journal: J Clin Exp Hepatol Date: 2017-05-25
Authors: Carla Osiowy; Ken Swidinsky; Sarah Haylock-Jacobs; Matthew D Sadler; Scott Fung; David Wong; Gerald Y Minuk; Karen E Doucette; Philip Wong; Edward Tam; Curtis Cooper; Alnoor Ramji; Mang Ma; Carmine Nudo; Keith Tsoi; Carla S Coffin Journal: JHEP Rep Date: 2022-02-22