High prevalence of hepatitis delta virus among people with hepatitis B virus and HIV coinfection in Botswana

• Main Authors: Kabo Baruti (Author), Bonolo B. Phinius (Author), Basetsana Phakedi (Author), Gorata Mpebe (Author), Wonderful Choga (Author), Lynnette Bhebhe (Author), Graceful Mulenga (Author), Natasha O. Moraka (Author), Tsholofelo Ratsoma (Author), Molly Pretorius-Holme (Author), Joseph Makhema (Author), Roger Shapiro (Author), Shahin Lockman (Author), Sikhulile Moyo (Author), Mosimanegape Jongman (Author), Motswedi Anderson (Author), Simani Gaseitsiwe (Author)
• Format: Book
• Published: Elsevier, 2023-11-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 1876-0341; 10.1016/j.jiph.2023.08.011
• Keywords: Prevalence; Hepatitis delta virus; People with HIV; Botswana; Infectious and parasitic diseases; RC109-216; Public aspects of medicine; RA1-1270
• Source: Journal of Infection and Public Health, Vol 16, Iss 11, Pp 1736-1741 (2023)

Background: Approximately 15-20 million people worldwide are infected with hepatitis delta virus (HDV), which is approximately 5 % of people with chronic hepatitis B virus (HBV). Sub-Saharan Africa has high HDV prevalence, leading to worse clinical outcomes among people who are HIV/HBV/HDV tri-infected. There are limited data on HDV prevalence among people with HIV (PWH) who are HBV-infected and uninfected in Botswana. We, therefore, determined HDV prevalence among PWH in Botswana. Methods: This was a retrospective cross-sectional study utilizing archived plasma samples from PWH with results for HBV markers such as hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), immunoglobulin M antibody to hepatitis B core antigen (IgM anti-HBc) and hepatitis B e antigen (HBeAg). Samples were categorized according to their HBsAg status and screened for anti-HDV antibodies. Total nucleic acid was extracted from samples with a single positive anti-HDV result, and HDV ribonucleic acid (RNA) load was quantified using the Altona Diagnostic RealStar® HDV RT-PCR kit. Statistical analysis was performed using STATA version 14.0 where p-values < 0.05 were considered statistically significant. Results: The study cohort (n = 478) included both HBsAg positive (44 %) and negative (56 %) participants, with a median age of 42 [IQR; 41-43]. Anti-HDV prevalence of (15/211) [7.1 %, 95 % CI: 4.4 - 11.4] was recorded among HBsAg positive participants, all of whom were IgM anti-HBc negative, while 5/6 participants were HBeAg negative. HDV RNA load was detected in 11/12 (92 %) anti-HDV-positive participants. No HDV prevalence was recorded among participants who were HBsAg negative, therefore, the overall HDV prevalence was (15/478) [3.1 %, 95 % CI: 1.9 - 5.1]. HIV viral load suppression was statistically insignificant, irrespective of HDV status. Conclusions: We report high HDV prevalence among HBsAg-positive PWH in Botswana. Most HDV-positive participants had active HDV infection, therefore, we recommend HDV screening in this cohort to guide their clinical care.