Siirt İlinde Yüksek Hepatit Delta Antikoru Sıklığı

Year 2021, Volume: 11 Issue: 1, 45 - 49, 21.01.2021

Tayibe Bal

https://doi.org/10.33631/duzcesbed.740550

Abstract

Amaç: Eş zamanlı hepatit delta virüs (HDV) enfeksiyonu varlığı kronik hepatit B (KHB) ilişkili karaciğer hastalığının seyrini olumsuz yönde etkilemektedir. Bu çalışmada Siirt ilinde hepatit B virusu (HBV) ile kronik olarak enfekte olan hepatit gelişmiş ve gelişmemiş olgularda delta antikoru (anti-HDV) sıklığının belirlenmesi ve HDV koenfeksiyonu varlığının klinik etkilerinin irdelenmesi amaçlanmıştır.
Gereç ve Yöntemler: Bu retrospektif kesitsel çalışmaya Şubat 2017-Şubat 2018 tarihleri arasında Siirt Devlet Hastanesi Enfeksiyon Hastalıkları polikliniğine başvuran Anti-HDV testi bakılmış 288’i HBV ile kronik olarak enfekte, 174’ü KHB gelişmiş toplam 462 olgu dahil edildi. HBV deoksiribonükleik asit (DNA), hepatit B “e” antijeni (HBeAg), alanin aminotransferaz (ALT), HDV ribonükleik asit (RNA) sonuçları ile siroz ve hepatosellüler karsinom (HCC) durumu ile ilgili verilere retrospektif olarak ulaşılmıştır. Çalışmaya alınan hastalar Anti-HDV pozitif (n=128) ve negatif (n=334) olmak üzere iki gruba ayrıldı. KHB, siroz ve HCC sıklığı gruplar arasında karşılaştırılmıştır.
Bulgular: Toplam 462 olgunun 205’i (%44,4) kadın, 257’si erkek (%55,6) olup, medyan yaşı 37 (çeyrekler arası aralık (IQR) 26 ila 49) idi. Anti-HDV pozitifliği saptanan toplam 128 (%27,8) olgunun 32’sinde HDV RNA çalışılabilmiş ve 9’unda pozitif olarak saptanmıştır. Çalışmamızda nonsirotik ve sirotik olgulardaki anti-HDV sıklığının sırasıyla %26,2 ve %68,8 olduğu görülmüştür. Anti-HDV pozitif olgularda KHB, siroz ve HCC sıklığının Anti-HDV negatif olgulara göre anlamlı oranda yüksek olduğu görülmüştür (p=0,003, p=0,001, p=0,021).
Sonuç: Bu çalışmada elde edilen verilere dayanarak, Siirt ilinde HBV ile enfekte olgularda Anti-HDV sıklığının Türkiye ortalamasının (%5,2) çok üzerinde olduğu ve Anti-HDV pozitif olguların KHB, siroz ve HCC gelişimi açısından Anti-HDV negatif olgulara oranla daha yakın izlem gerektirdiği söylenebilir.

Keywords

Hepatit delta virüs, hepatosellüler karsinom, kronik hepatit B, siroz

High Prevalence of Hepatitis Delta Antibody in Siirt Province

Abstract

Aim: The presence of concomitant hepatitis delta virus (HDV) infection negatively affects the course of chronic hepatitis B (CHB) related liver disease. In this study, it was aimed to determine the frequency of delta antibody (anti-HDV) and to investigate the clinical effects of hepatitis delta virus (HDV) coinfection in patients with CHB and who are chronically infected with hepatitis B virus (HBV) in Siirt.
Material and Methods: In this retrospective cross-sectional study, a total of 462 cases, 288 of whom were chronically infected with HBV and 174 with CHB, who were admitted to the Siirt State Hospital Infectious Diseases outpatient clinic between February 2017 and February 2018, were included. Data on HBV deoxyribonucleic acid (DNA), hepatitis “e” antigen (HBeAg), alanine aminotransferase (ALT), HDV ribonucleic acid (RNA) results and cirrhosis and hepatocellular carcinoma (HCC) status were accessed retrospectively. The patients included in the study were divided into two groups as anti-HDV positive (n=128) and negative (n=334). The frequency of CHB, cirrhosis and HCC were compared between the groups.
Results: Of the 462 cases in total, 205 (44.4%) were female and 257 (55.6%) were male and the median age was 37 (interquartile range (IQR): 26 to 49). Anti-HDV was positive in 128 (27.8%) of these cases, only 32 cases were examined for HDV RNA and 9 were positive. In our study, the frequency of anti-HDV in non-cirrhotic and cirrhotic cases was found to be 26.2% and 68.8%, respectively. It was observed that the frequency of CHB, cirrhosis and HCC were significantly higher in anti-HDV positive cases compared to anti-HDV negative cases (p=0.003, p=0.001, p=0.021).
Conclusion: Based on the data obtained from the present study, we consider that, in Siirt province, the prevalence of anti-HDV in the patients infected with HBV is much higher than average for Turkey. Additionally, it can be said that anti-HDV positive cases require closer monitoring compared to anti-HDV negative cases in terms of CHB, cirrhosis and HCC development.

Keywords

Hepatitis delta virus, chronic hepatitis B, cirrhosis, hepatocellular carcinoma

References

• 1. Lin JH, Chang MF, Baker SC, Govindarajan S, Lai MM. Characterization of hepatitis delta antigen: specific binding to hepatitis delta virus RNA. J Virol. 1990; 64(9): 4051-8.
• 2. Chen HY, Shen DT, Ji DZ, Han PC, Zhang WM, Ma JF, et al. Prevalence and burden of hepatitis D virus infection in the global population: a systematic review and meta-analysis. Gut. 2019; 68(3): 512-21.
• 3. Shen DT, Ji DZ, Chen HY, Goyal H, Pan S, Xu HG. Hepatitis D: not a rare disease anymore: global uptodate for 2017-2018. Gut. 2020; 69(4): 786-8.
• 4. Yurdaydin C, Toy M. Hepatitis delta virus infection: a large burden after all ? J Infect Dis. 2020; 221(10): 1573-5.
• 5. Miao Z, Zhang S, Ou X, Li S, Ma Z, Wang W, et al. Estimating the global prevalence, disease progression, and clinical outcome of hepatitis delta virus infection. J Infect Dis. 2020; 221(10): 1677-87.
• 6. Wedemeyer H, Negro F. Devil hepatitis D: an orphan disease or largely underdiagnosed? Gut. 2019; 68(3): 381-2.
• 7. Mhalla S, Kadri Y, Alibi S, Letaief A, Boukadida J, Hannachi N. Hepatitis D virus infection among hepatitis B surface antigen carriers and in “isolated anti-HBc” antibodies profile in central Tunisia. Hepat Mon. 2016; 16(1): e32354.
• 8. Dulger AC, Suvak B, Gonullu H, Gonullu E, Gultepe B, Aydın I, et al. High prevalence of chronic hepatitis D virus infection in Eastern Turkey: urbanization of the disease. Arch Med Sci. 2016; 12(2): 415-20.
• 9. Değertekin H, Yalçin K, Yakut M. The prevalence of hepatitis delta virus infection in acute and chronic liver diseases in Turkey: an analysis of clinical studies. Turk J Gastroenterol. 2006; 17(1): 25-34.
• 10. European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2017; 67(2): 370-98.
• 11. Ayaz C, Tekin Koruk S, Yalci A, Yamazhan T, Aygen B, Tosun S, et al. Epidemiology and risk factors of hepatitis delta infection in Turkey. J Pure Appl Microbio. 2013; 7(4): 2809-13.
• 12. Celen MK, Ayaz C, Hosoglu S, Geyik MF, Ulug. M. Anti-hepatitis delta virus seroprevalence and risk factors in patients with hepatitis B in Southeast Turkey. Saudi Med. J. 2006; 27(5): 617-20.
• 13. Tunç N, Eraydın H, Çetinkaya E, Oduncu MK, Toy Ş. Siirt Devlet Hastanesi’ne başvuran hastalarda HBsAg, Anti-HBs, Anti-HCV ve Anti-HIV seroprevalansı. Viral Hepatit Derg. 2011; 17(1): 7-11.
• 14. Arabacı F, Şahin HA, Şahin İ, Kartal Ş. Kan donörlerinde HBV, HCV, HIV ve VDRL seropozitifliği. Klimik Derg. 2003; 16(1): 18-20.
• 15. Parlak E, Ertürk A, Parlak M, Koşan Z, Albayrak A, Özkurt Z, et al. Assessment of patients with hepatitis D. Viral Hepatitis Journal. 2015; 21(3): 80-4.
• 16. Ayaz C, Yardımcı C, Çandır N, Ersöz G, Şanlıdağ T, Tığlı A, ve ark. Kronik hepatit D virusu infeksiyonunun yönetimi: Türk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği Viral Hepatit Çalışma Grubu Uzlaşı Raporu. Klimik Derg. 2014; 27(1): 40-7.
• 17. Parlak E, Ertürk A, Parlak M, Koşan Z, Albayrak A, Öztürk Z, et al. Assessment of patients with hepatitis D. Viral Hepat J. 2015; 21(3): 80-4.
• 18. Yolcu A, Karabulut N, Alaçam S, Önel M, Büyük M, Güllüoğlu M, et al. Frequency of hepatitis delta virus in hepatitis B surface-antigen-positive patients. Viral Hepat J. 2019; 25(1): 14-8.
• 19. Negro F, Bergmann KF, Baroudy BM, Satterfield WC, Popper H, Purcell RH, et al. Chronic hepatitis D virus (HDV) infection in hepatitis B virus carrier chimpanzees experimentally superinfected with HDV. J Infect Dis. 1988; 158(1): 151-9.
• 20. Borghesio E, Rosina F, Smedile A, Lagget M, Niro MG, Marinucci G, et al. Serum immunglobulin M antibody to hepatitis D as a surrogate marker of hepatitis D in interferon-treated patients and in patients who underwent liver transplantation. Hepatology. 1998; 27(3): 873-6.
• 21. Bahcecioglu IH, Aygun C, Gozel N, Poyrazoğlu OK, Bulut Y, Yalniz M. Prevalence of hepatitis delta virus (HDV) infection in chronic hepatitis B patients in eastern Turkey: still a serious problem to consider. J Viral Hepat. 2011; 18(7): 518-24.
• 22. Noureddin M, Gish R. Hepatitis Delta: Epidemiyoloji, diagnosis and management 36 years after discovery. Curr Gastroenterol Rep. 2014; 16(1): 365.
• 23. Fattovich G. Natural history and prognosis of chronic hepatitis B. Semin Liver Dis. 2003; 23(1): 47-58.
• 24. Amini N, Alavian SM, Kabir A, Saiedi Hosseini SY, Aalaei Andabili SH. Clinical features and seroepidemiology of anti-HDV Antibody in patients with chronic hepatitis B virus infection in Iran: a meta-analysis. Hepat Mon. 2011; 11(12): 960-7.
• 25. Aberra H, Gordien E, Desalegn H, Berhe N, Medhin G, Mekasha B, et al. Hepatitis delta virus infection in a large cohort of chronic hepatitis B patients in Ethiopia. Liver Int. 2018; 38(6): 1000-9.
• 26. Fouad R, Abdo M, Eldeen HG, Sabry D, Atef M, Ahmed R, et al. Influence of delta virus infection on the virologic status in Egyptian patients with chronic hepatitis B virus genotype D. J Med Virol. 2016; 88(5): 837-42.
• 27. Ghamari S, Alavian SM, Rizzetto M, Olivera A, Smedile A, Khedive A, et al. Prevalence of hepatitis delta virus (HDV) infection in chronic hepatitis B patients with unusual clinical pictures. Hepat Mon. 2013; 13(38): e6731.
• 28. Schaper M, Rodriguez-Frias F, Jardi R, Tabernero D, Homs M, Ruiz G, et al. Quantitative longitudinal evaluations of hepatitis delta virus RNA and hepatitis B virus DNA shows a dynamic, complex replicative profile in chronic hepatitis B and D. J Hepatol. 2010; 52(5): 658-64.
• 29. Wedemeyer H. Re-emerging interest in hepatitis delta: new insights into the dynamic interplay between HBV and HDV. J Hepatol. 2010; 52(5): 627-9.