Prospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 27, 2024; 16(4): 640-649
Published online Apr 27, 2024. doi: 10.4254/wjh.v16.i4.640
Prospective study of hepatitis B and D epidemiology and risk factors in Romania: A 10-year update
Speranta Iacob, Liana Gheorghe, Mirela Onica, Laura Huiban, Corina Silvia Pop, Ciprian Brisc, Roxana Sirli, Carmen Ester, Cristina Mihaela Brisc, Sorina Diaconu, Ion Rogoveanu, Larisa Sandulescu, Deiana Vuletici, Anca Trifan
Speranta Iacob, Liana Gheorghe, Mirela Onica, Corina Silvia Pop, Carmen Ester, Sorina Diaconu, Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
Speranta Iacob, Liana Gheorghe, Mirela Onica, Carmen Ester, Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest 022328, Romania
Laura Huiban, Department of Gastroenterology, Grigore T Popa University of Medicine and Pharmacy, Iasi 700115, Romania
Laura Huiban, Anca Trifan, Institute of Gastroenterology and Hepatology, Saint Spiridon County Hospital, Iasi 700111, Romania
Corina Silvia Pop, Department of Gastroenterology and Medical Oncology, University Emergency Clinical Hospital, Bucharest 050098, Romania
Ciprian Brisc, Cristina Mihaela Brisc, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410087, Romania
Ciprian Brisc, Cristina Mihaela Brisc, Department of Gastroenterology, Emergency County Hospital, Oradea 410169, Romania
Roxana Sirli, Deiana Vuletici, Center for Advanced Research in Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, “Victor Babeş” University of Medicine and Pharmacy, Timisoara 300041, Romania
Roxana Sirli, Deiana Vuletici, Department of Gastroenterology and Hepatology, Timiş County Emergency Clinical Hospital "Pius Branzeu", Timisoara 300723, Romania
Sorina Diaconu, Department of Internal Medicine II and Gastroenterology, University Emergency Clinical Hospital, Bucharest 050098, Romania
Ion Rogoveanu, Department of Gastroenterology, University of Medicine and Pharmacy, Craiova 200349, Romania
Ion Rogoveanu, Department of Cardiology, Emergency County Hospital, Craiova 200642, Romania
Larisa Sandulescu, Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova 200349, Romania
Larisa Sandulescu, Department of Gastroenterology, Emergency County Hospital, Craiova 200642, Romania
Anca Trifan, Department of Gastroenterology, Faculty of Medicine, Grigore T Popa University of Medicine and Pharmacy, Iasi 700115, Romania
Author contributions: Iacob S, Gheorghe L, Pop CS, and Trifan A were involved in the study design and concept; Onica M, Huiban L, Brisc C, Sirli R, Ester C, Brisc CM, Diaconu S, Rogoveanu I, Sandulescu L, and Vuletici D acquired the data; Iacob S performed the data analysis; Iacob S and Gheorghe L interpreted the data; all authors were involved in drafting the manuscript, provided critical revisions for important intellectual content, approved the final version submitted for publication and agreed to be accountable for all aspects of the work.
Supported by Gilead Sciences Europe Ltd.
Institutional review board statement: The study was approved by the institutional ethics committees and conformed to the ethical guidelines of the 1975 Declaration of Helsinki. Fundeni Clinical Institute obtained the ethical approval to enrol patients across all hospitals included in this study.
Informed consent statement: All study participants provided informed written consent before study enrolment.
Conflict-of-interest statement: Medical writing support was provided by Joe Jones, PhD, of PharmaGenesis London, London, United Kingdom, with funding provided by Gilead Sciences Europe Ltd.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Liana Gheorghe, MD, PhD, Doctor, Professor, Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Dionisie Lupu Street 37, Bucharest 050474, Romania. drlgheorghe@gmail.com
Received: December 6, 2023
Peer-review started: December 6, 2023
First decision: January 19, 2024
Revised: February 19, 2024
Accepted: March 22, 2024
Article in press: March 22, 2024
Published online: April 27, 2024
Abstract
BACKGROUND

The global burden of hepatitis D virus (HDV) infection represents a major medical challenge and a public health crisis worldwide. However, there is a lack of accurate data on the epidemiology and risk factors for HDV. Hepatitis B virus (HBV) and HDV coinfection causes the most severe form of viral hepatitis, leading to a higher cumulative incidence of liver-related events compared with HBV monoinfection, including the need for liver transplantation and death.

AIM

To investigate the epidemiology, natural history, risk factors and clinical management of HBV and HDV coinfection in Romanian patients.

METHODS

This prospective study was conducted between January and July 2022 in six tertiary gastroenterology and hepatology referral centres in Romania. All consecutive adults admitted for any gastroenterology diagnosis who were HBV-positive were enrolled. Patients with acute hepatitis or incomplete data were excluded. Of the 25390 individuals who presented with any type of gastroenterology diagnosis during the study period, 963 met the inclusion criteria. Testing for anti-HDV antibodies and HDV RNA was performed for all participants. Demographic and risk factor data were collected by investigators using medical charts and patient questionnaires. All data were stored in an anonymized online database during the study.

RESULTS

The prevalence of HBV was 3.8%; among these patients, the prevalence of HBV/HDV coinfection was 33.1%. The median age of the study population was 54.0 years, and it consisted of 55.1% men. A higher prevalence of HBV/HDV coinfection was observed in patients 50–69 years old. Patients with HBV/HDV coinfection were significantly older than those with HBV monoinfection (P = 0.03). Multivariate multiple regression analysis identified female gender (P = 0.0006), imprisonment (P < 0.0001), older age at diagnosis (P = 0.01) and sexual contact with persons with known viral hepatitis (P = 0.0003) as significant risk factors for HDV.

CONCLUSION

This study shows that HDV infection among those with HBV remains endemic in Romania and updates our understanding of HDV epidemiology and associated risk factors. It emphasizes the need for systematic screening for HDV infection and collaborative initiatives for controlling and preventing HBV and HDV infection.

Keywords: Epidemiology, Hepatitis B, Hepatitis D, Natural history, Risk factors, Romania

Core Tip: In this study, we investigated the epidemiology, natural history, risk factors and clinical management of hepatitis B virus (HBV) and hepatitis D virus (HDV) coinfection in Romanian patients. We found that HDV infection among those with HBV remains endemic and identified the following significant risk factors associated with HBV/HDV chronic hepatitis: female gender, older age at diagnosis, sexual contact with persons with known viral hepatitis and imprisonment. This study emphasizes the need for systematic screening for HDV infection, subsequent reflex testing of HDV RNA and collaborative initiatives for controlling, treating and preventing HBV and HDV infection.