Published online Jun 27, 2020. doi: 10.4254/wjh.v12.i6.277
Peer-review started: February 9, 2020
First decision: March 18, 2020
Revised: April 7, 2020
Accepted: May 5, 2020
Article in press: May 5, 2020
Published online: June 27, 2020
At present, epidemiological data and information regarding possible changes in the infected patient's profile are scarce. In addition, there were no updated epidemiological data in our region for three decades.
To carry out this research in Spain is of special interest given the idiosyncrasies of our country, and especially of our Region, Comunidad Valenciana, as an immigration receiving area.
The main objective was to describe the prevalence and profile of the hepatitis D virus (HDV) infection in our referral hospital. Secondary objectives were as follows: (1) To determine the epidemiology of the HDV infection; (2) To assess risk factors associated with this infection and determine whether the disease course is worse than in hepatitis B virus (HBV) mono-infected patients of the same age and sex; and (3) To elucidate whether the recommendations of the European guidelines for treatment are met.
Retrospective evaluation of anti-HDV-immunoglobulin G seroprevalence among patients with chronic HBV infection followed in a reference Hepatology Unit. Demographic, clinical, analytic, serologic, and virology parameters were retrieved from chart review together with evolution events (cirrhosis, liver decompensation, liver transplantation, and death). HDV-HBV patients were matched 1:1 by age and year of diagnosis to HBV mono-infected patients.
Most of anti-HDV-IgG patients were men (63%) with a median age of 52 years. The majority were Spaniards (67%), who were infected due to intravenous drug use; 24.5% of the population corresponded to migrants, presumably due to a nosocomial infection. Comorbidities (diabetes, alcohol consumption and overweight) were frequent in both groups. A high proportion of patients developed liver complications such as cirrhosis (77%), liver decompensation (81%), or HCC (16.5%), or required liver transplantation (59.5%). Compared to HBV mono-infected patients, delta individuals more frequently developed cirrhosis and liver decompensation, with no differences in HCC rates. The main limitation of this study lies in its retrospective quality. Therefore, we must base our conclusions on the current sample and follow patients prospectively in order to continue updating their data. Future research should collect virological data (HDV viral load) and determine the genotype in order to elucidate the role of these factors and determine if it is possible to ascertain individualized evolutionary courses according to the characteristics previously exposed.
We confirmed our hypothesis that the HDV-infected population has changed starting in 2000 due to an increase in the immigrant population. However, the disease outcomes remain the same: Cirrhosis, impaired liver function and HCC. We have found a high prevalence of delta hepatitis in our area compared to other Spanish and European regions; probably because increased number of immigrants. This implies that we must be very diligent in screening for this infection in order to be able to offer patients early follow-up.
Delta hepatitis remains a major concern and must follow these patients carefully given the significant complications seen on follow-up. Future research should elucidate the behavior of patients diagnosed over the last decade.