Background: HDV-prevalence in Italy and its fluctuations over-time are controversial. Furthermore, an extensive characterization of HDV-infected patients is still missing. Methods: The rate of HDV-seroprevalence and HDV-chronicity was assessed in 1,579 HBsAg+patients collected from 2005 to 2022 in Central-Italy. Results: 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 ALT<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-RNA (median[IQR]:4.6[3.6-5.6]logcopies/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 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]logcopies/ml, P=0.016) and HBsAg (9,461[4,159-24,532] vs 4,447[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. Conclusion: 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 tends to scarcely decline in native/non-native patients. Detection of subgenotypes, triggering variable inflammatory stimuli, supports the need to expand HDV molecular characterization.
Salpini, R., Piermatteo, L., Torre, G., D'Anna, S., Khan, S., Duca, L., et al. (2024). Prevalence of HDV infection in Central Italy has remained stable across the last two decades with dominance of sub-genotypes 1 and characterized by elevated viral replication. INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES, 138, 1-9 [10.1016/j.ijid.2023.11.005].
Prevalence of HDV infection in Central Italy has remained stable across the last two decades with dominance of sub-genotypes 1 and characterized by elevated viral replication
Piermatteo, Lorenzo;Torre, Giulia;D'Anna, Stefano;Khan, Sohaib;Duca, Leonardo;Bertoli, Ada;La Frazia, Simone;Malagnino, Vincenzo;Teti, Elisabetta;Iannetta, Marco;Lenci, Ilaria;Francioso, Simona;Santopaolo, Francesco;Ceccherini-Silberstein, Francesca;Baiocchi, Leonardo;Grelli, Sandro;Sarmati, Loredana;Svicher, Valentina
2024-01-01
Abstract
Background: HDV-prevalence in Italy and its fluctuations over-time are controversial. Furthermore, an extensive characterization of HDV-infected patients is still missing. Methods: The rate of HDV-seroprevalence and HDV-chronicity was assessed in 1,579 HBsAg+patients collected from 2005 to 2022 in Central-Italy. Results: 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 ALT<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-RNA (median[IQR]:4.6[3.6-5.6]logcopies/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 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]logcopies/ml, P=0.016) and HBsAg (9,461[4,159-24,532] vs 4,447[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. Conclusion: 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 tends to scarcely decline in native/non-native patients. Detection of subgenotypes, triggering variable inflammatory stimuli, supports the need to expand HDV molecular characterization.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.