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 Table of Contents  
LETTERS TO EDITOR
Year : 2020  |  Volume : 5  |  Issue : 1  |  Page : 96-97

Molecular epidemiology of hepatitis delta virus among blood donors in Islamabad, Pakistan


1 Department of Pathology and Transfusion Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, PIMS; Safe Blood Transfusion Programme, Ministry of National Health Services, Islamabad, Pakistan
2 Peshawar Regional Blood Centre, Department of Health, Khyber Pakhtunkhwa, Pakistan
3 Department of Biological Sciences, International Islamic University, Islamabad, Pakistan

Date of Web Publication17-Apr-2020

Correspondence Address:
Usman Waheed
Department of Pathology and Transfusion Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, PIMS; Safe Blood Transfusion Programme, Ministry of National Health Services, Islamabad
Pakistan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/GJTM.GJTM_4_20

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How to cite this article:
Waheed U, Saba Ne, Wazeer A, Farooq A, Arshad M, Zaheer HA. Molecular epidemiology of hepatitis delta virus among blood donors in Islamabad, Pakistan. Glob J Transfus Med 2020;5:96-7

How to cite this URL:
Waheed U, Saba Ne, Wazeer A, Farooq A, Arshad M, Zaheer HA. Molecular epidemiology of hepatitis delta virus among blood donors in Islamabad, Pakistan. Glob J Transfus Med [serial online] 2020 [cited 2020 Aug 9];5:96-7. Available from: http://www.gjtmonline.com/text.asp?2020/5/1/96/282737



Sir,

First reported in 1977,[1] the hepatitis delta virus (HDV) is a single-stranded RNA virus with a significant impact on global health. It appears only as a co-infection in patients harboring the hepatitis B virus (HBV) and about 5% of the global HBV-positive population is co-infected with HDV. This co-infection results in more severe disease, cirrhosis, liver carcinoma, and higher mortality rate.[2] When anti-HDV antibodies are identified in high titers in hepatitis B surface antigen (HBsAg) chronic carriers, it is termed superinfection and co-infection if the titers are low.[3] As there is no satisfactory therapy for HDV treatment (the only option available is interferon-alpha),[4] screening for HDV has been limited historically, but the increasing incidence and epidemiology together with the severity of this form of hepatitis, highlight the need for increased HDV testing among HBV patients.

The epidemiology of HDV is well studied in advanced countries, but limited information is available on the prevalence of HDV in the Pakistani population, especially in the blood donors. The current study was planned with the objective to investigate the molecular epidemiology of HDV among blood donors in Islamabad, Pakistan.

The study was conducted in the Department of Pathology and Transfusion Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, PIMS, Islamabad, from July to December 2019. Ethical approval was granted by the University Ethics Committee. A total of 15,974 blood donors were screened for HBsAg by chemiluminescence immunoassay on Abbott's Architect system (Abbott Laboratories, USA) using plasma samples. The total anti-HDV antibodies were tested by Liaison XL murex assay (DiaSorin S.p.A., Italy). To determine the presence of HDV RNA, viral RNA was extracted by ExiPrep™ Dx Viral RNA extraction kit. After the RNA extraction, reverse transcription procedure was performed where the RNA was reverse transcribed using a commercially available kit (Thermo fisher scientific) into complementary DNA which was amplified by polymerase chain reaction and analyzed by 1% agarose gel electrophoresis.

The results indicated that the majority of the blood donors were males (98%) with a mean age of 27.4 years. The HBsAg positivity was seen in 1.40% (n = 224) of blood donors. The HDV prevalence in this group was 13.8% (n = 31). HDV-RNA was detected in 70.9% (n = 22) of anti-HDV-positive patients.

Earlier reports from Pakistan have reported the prevalence of HDV in chronic HBV-infected patients as 28.1%,[5] 35.2%,[6] 58.6%,[7] and as high as 88.8%.[8] The prevalence rates in neighboring countries, including Iran (16.6%)[3] and Turkey (15.7%),[9] are comparable with our study while those from Egypt (43%)[10] are comparatively higher. The study showed a declining trend in the prevalence of HDV which may be attributed to increased awareness and effective immunization against HBV.

The HBV-HDV co-infection prevalence is still high. The study necessitates firm laboratory and clinical surveillance in HBV-infected patients to monitor HDV. Further transmission should be prevented through vaccination against HBV. More studies are needed at the genetic level to determine the common genotype of HDV disease at the national level.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rizzetto M, Canese MG, Aricò S, Crivelli O, Trepo C, Bonino F, et al. Immunofluorescence detection of new antigen-antibody system (delta/anti-delta) associated to hepatitis B virus in liver and in serum of HBsAg carriers. Gut 1977;18:997-1003.  Back to cited text no. 1
    
2.
Coller KE, Butler EK, Luk KC, Rodgers MA, Cassidy M, Gersch J, et al. Development and performance of prototype serologic and molecular tests for hepatitis delta infection. Sci Rep 2018;8:2095.  Back to cited text no. 2
    
3.
Attaran MS, Sharifi Z, Hosseini SM, Samei S, Ataee Z. Prevalence of hepatitis B and hepatitis D coinfection in asymptomatic blood donors in Iran. APMIS 2014;122:243-7.  Back to cited text no. 3
    
4.
Koytak ES, Yurdaydin C, Glenn JS. Hepatitis D. Curr Treat Options Gastroenterol 2007;10:456-63.  Back to cited text no. 4
    
5.
Abbasi A, Bhutto AR, Butt N, Mahmood K. HDV seroprevalence in HBsAg positive patients. J Coll Physicians Surg Pak 2014;24:624-7.  Back to cited text no. 5
    
6.
Mumtaz K, Ahmed US, Memon S, Khawaja A, Usmani MT, Moatter T, et al. Virological and clinical characteristics of hepatitis delta virus in South Asia. Virol J 2011;8:312.  Back to cited text no. 6
    
7.
Seetlani NK, Abbas Z, Raza S, Yakoob J, Jafris W. Prevalence of hepatitis D in HBsAg positive patients visiting liver clinics. J Pak Med Assoc 2009;59:434-7.  Back to cited text no. 7
    
8.
Zaidi G, Idrees M, Malik FA, Amin I, Shahid M, Younas S, et al. Prevalence of hepatitis delta virus infection among hepatitis B virus surface antigen positive patients circulating in the largest province of Pakistan. Virol J 2010;7:283.  Back to cited text no. 8
    
9.
Dulger AC, Suvak B, Gonullu H, Gonullu E, Gultepe B, Aydın İ, et al. High prevalence of chronic hepatitis D virus infection in Eastern Turkey: Urbanization of the disease. Arch Med Sci 2016;12:415-20.  Back to cited text no. 9
    
10.
Makhlouf NA, Morsy KH, Mahmoud AA. Hepatitis D virus infection among hepatitis B virus surface antigen positive individuals in Upper Egypt: Prevalence and clinical features. J Infect Public Health 2019;12:350-6.  Back to cited text no. 10
    




 

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