研究发现，42％的HBV成人与HDV合并感染

StephenW

PerspectiveIn the Journals Plus
42% of adults with HBV are coinfected with HDV, study finds

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January 11, 2019
Eshan U. Patel, MPH
Eshan U. Patel

In the United States, 42% of adults with hepatitis B virus are coinfected with hepatitis D, suggesting a need for routine HDV testing among people with HBV, according to study findings.

Eshan U. Patel, MPH, and colleagues from Johns Hopkins University said the results of their study suggest that the prevalence of HDV in the U.S. is “significantly higher” than previously acknowledged.

According to Patel and colleagues, the American Association for the Study of Liver Diseases recommends that patients who are positive for hepatitis B surface antigen (HBsAg) and at high-risk for HDV infection also be tested for the presence of HDV antibodies.

“Given that a high percentage of HBsAg-positive individuals in the study had antibodies to HDV, clinicians should consider routine HDV antibody testing for all HBsAg-positive patients,” Patel told Infectious Disease News. “Clinicians should also recommend vaccination against HBV infection to patients in all recommended populations to help prevent HBV and HDV transmission.”
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Patel noted that most people living with HBV are unaware of their infection, and that efforts are needed increase screening.

Screening patients for HBV susceptibility or infection, then vaccinating or treating them appropriately, was recently found to be cost effective, according to study findings published in Open Forum Infectious Diseases.

Unlike HBV, HDV is not a nationally notifiable infection and commercial RNA assays are not widely available, according to Patel and colleagues. For their study, they estimated the prevalence of ongoing HBV infections and seroprevalence of HDV infections in the U.S. using population-based data from the National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey conducted by the National Center for Health Statistics on a continuous basis. Patel and colleagues used pooled data collected from 21,832 NHANES respondents with complete data on demographic characteristics from 2011 to 2016.

According to the study findings, the prevalence of HBsAg among the total population aged 6 years or older was 0.28%. Of these, the prevalence of antibodies to HDV was 0.11%. When Patel and colleagues assessed only adults aged 18 years or older, they found a prevalence of 0.36% for HBsAg and 0.15% for antibodies to HDV. The highest prevalence of HBsAg and HDV was observed among Asian and foreign-born adults.

All adults who were positive for HDV were also HBsAg positive, Patel and colleagues noted. According to the study, 42% of the 113 HBsAg-positive adults were positive for HDV, with a 33% prevalence rate among HBsAg-positive U.S.-born adults and 46% among HBsAg-positive foreign-born adults. Among Asian HBsAg-positive adults, HDV prevalence was 45% compared with 39% of adults of all other races and identities.

Patel and colleagues also found that HBV/HDV coinfected adults had higher serological markers associated with liver disease, especially compared with uninfected adults. Among HBsAg-positive adults, 30% (95% CI, 17%-46%) of individuals also positive for HDV reported a liver disease diagnosis compared with 9% (95% CI, 5%-16%) of those who were negative for HDV antibodies.

Between 2013 and 2016, NHANES included a question inquiring if the respondent was ever diagnosed with hepatitis B. They found that only 33% (95% CI, 18%-51%) of HBsAg-positive adults were aware of their infection. Among HBsAg-positive adults with HDV antibodies, awareness of HBV infection was 47% (95% CI, 27%-68%) compared with 15% (95% CI, 6%-32%) among HBsAg-positive adults without HDV, according to the study.

Although it was not evaluated in this study, Patel said that patients with HBV/HDV coinfection have worse clinical outcomes compared with HBV-monoinfected patients. – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.

StephenW

PerspectiveIn the Journals Plus
研究发现，42％的HBV成人与HDV合并感染

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2019年1月11日
Eshan U. Patel，MPH
Eshan U. Patel

根据研究结果，在美国，42％的乙型肝炎病毒成人合并了丁型肝炎，这表明需要对HBV患者进行常规HDV检测。

来自约翰霍普金斯大学的Eshan U. Patel，MPH和同事表示，他们的研究结果表明，美国HDV的患病率“显着高于”之前公认的水平。

根据Patel及其同事的说法，美国肝病研究协会建议，对乙型肝炎表面抗原（HBsAg）呈阳性且HDV感染高风险的患者也要检测是否存在HDV抗体。

“鉴于该研究中高比例的HBsAg阳性个体患有HDV抗体，临床医生应考虑对所有HBsAg阳性患者进行常规HDV抗体检测，”Patel告诉传染病新闻。 “临床医生还应该建议所有推荐人群接种HBV感染疫苗，以帮助预防HBV和HDV传播。”
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Patel指出，大多数患有HBV的人都没有意识到他们的感染，需要加大筛查力度。

根据Open Forum Infectious Diseases发表的研究结果，最近发现筛查患者的HBV易感性或感染，然后适当地接种或治疗它们是符合成本效益的。

根据Patel及其同事的说法，与HBV不同，HDV不是一种全国性的通报感染，商业RNA检测并不广泛。在他们的研究中，他们使用来自国家健康和营养检查调查（NHANES）的人口数据估算了美国正在进行的HBV感染和HDV感染的血清阳性率，这是一项由国家卫生统计中心进行的横断面调查。持续不断。 Patel及其同事使用从21,832名NHANES受访者收集的汇总数据，以及2011年至2016年的人口统计特征的完整数据。

根据研究结果，6岁以上人口中HBsAg的患病率为0.28％。其中，HDV抗体的流行率为0.11％。当Patel及其同事仅评估18岁或18岁以上的成年人时，他们发现HBsAg的患病率为0.36％，HDV抗体的患病率为0.15％。在亚洲和外国出生的成年人中观察到HBsAg和HDV的患病率最高。

Patel及其同事指出，所有HDV阳性的成人也都是HBsAg阳性。根据该研究，113例HBsAg阳性成人中有42％为HDV阳性，HBsAg阳性美国出生成人患病率为33％，HBsAg阳性外国出生成人患病率为46％。在亚洲HBsAg阳性成人中，HDV患病率为45％，而所有其他种族和身份的成人为39％。

Patel及其同事还发现HBV / HDV合并感染的成人具有较高的与肝病相关的血清学标志物，特别是与未感染的成人相比。在HBsAg阳性成人中，30％（95％CI，17％-46％）HDV阳性者报告肝病诊断，而阴性者为9％（95％CI，5％-16％）对于HDV抗体。

在2013年至2016年期间，NHANES包括一个询问受访者是否曾被诊断患有乙型肝炎的问题。他们发现只有33％（95％CI，18％-51％）的HBsAg阳性成人知道他们的感染。在患有HDV抗体的HBsAg阳性成人中，HBV感染的意识为47％（95％CI，27％-68％），而没有HDV的HBsAg阳性成人为15％（95％CI，6％-32％），根据这项研究。

虽然在本研究中未对其进行评估，但Patel表示，与HBV单一感染患者相比，HBV / HDV合并感染患者的临床结果更差。 -  Marley Ghizzone

披露：作者报告没有相关的财务披露。

pourvivre

回复 StephenW 的帖子

你好，
引用：——在亚洲HBsAg阳性成人中，HDV患病率为45％，而所有其他种族和身份的成人为39％。——

问：是否有中国大陆或台湾，香港 HBsAg阳性成人中，HDV患病率的百分比数据？

谢谢！

StephenW

回复 pourvivre 的帖子

上述报告报道，45％的HBV患者在美国有HDV共感染.这个数字很高，也许只是他的样本或他对HDV的测试不完整.
据世卫组织称:
Geographical distribution

It is estimated that globally, approximately 5% of people with chronic HBV infection are co-infected with HDV, resulting in a total of 15 – 20 million persons infected with HDV worldwide. High-prevalence areas include Africa (Central and West Africa), Asia (Central and Northern Asia, Viet Nam, Mongolia, Pakistan, Japan, and Chinese Taipei), Pacific Islands (Kiribati, Nauru), Middle East (all countries), Eastern Europe (Eastern Mediterranean regions, Turkey), South America (Amazonian basin), and Greenland. However, the global estimation and geographic information are incomplete because many countries do not report the prevalence of HDV.
据估计，全球约有5％的慢性HBV感染者与HDV共感染，导致全世界共有1500万至2000万人感染HDV。 流行率高的地区包括非洲（中非和西非），亚洲（中亚和北亚，越南，蒙古，巴基斯坦，日本和中国台北），太平洋岛屿（基里巴斯，瑙鲁），中东（所有国家），东部 欧洲（东地中海地区，土耳其），南美洲（亚马逊流域）和格陵兰岛。 然而，全球估计和地理信息不完整，因为许多国家没有报告HDV的流行情况。.

我认为蒙古在中国的HDV感染率最高，约占总人口的4.5％ (HBV约占总人口的10.6％）.

pourvivre

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谢谢你的答复。继续关注类似信息