Hepatitis D virus (HDV) infection causes the most severe form of viral hepatitis with rapid progression to cirrhosis, hepatic decompensation, and hepatocellular carcinoma. Although discovered > 40 years ago, little attention has been paid to this pathogen from both scientific and public communities. However, effectively combating hepatitis D requires advanced scientific knowledge and joint efforts from multi-stakeholders. In this review, we emphasized the recent advances in HDV virology, epidemiology, clinical feature, treatment, and prevention. We not only highlighted the remaining challenges but also the opportunities that can move the field forward.
Carcinoma, Hepatocellular/complications* ; Hepatitis B virus ; Hepatitis D/epidemiology* ; Hepatitis Delta Virus/genetics* ; Humans ; Liver Cirrhosis/etiology* ; Liver Neoplasms/complications*

BACKGROUND/AIMS: Mongolia has one of the highest hepatitis A, C, B and D infection incidences worldwide. We sought to investigate changes in the proportion of acute viral hepatitis types in Mongolia over the last decade. METHODS: The cohort comprised 546 consecutive patients clinically diagnosed with acute viral hepatitis from January 2012 to December 2014 in Ulaanbaatar Hospital, Mongolia. A time trend analysis investigating the change in proportion of acute hepatitis A virus, hepatitis C virus (HCV), hepatitis B virus (HBV) and hepatitis delta virus (HDV) infection among the cohort with respect to a previous published study was undertaken. RESULTS: Acute hepatitis A, B and C was diagnosed in 50.9%, 26.2% and 6.0% of the cohort. Notably, 16.8% of the cohort had a dual infection. The etiologies of acute viral hepatitis were varied by age groups. The most common cause of acute viral hepatitis among 2-19 year olds was hepatitis A, HBV and superinfection with HDV among 20-40 year olds, and HCV among 40-49 year olds. Patients with more than one hepatitis virus infection were significantly older, more likely to be male and had a higher prevalence of all risk factors for disease acquisition. These patients also had more severe liver disease at presentation compared to those with mono-infection. CONCLUSIONS: Acute viral hepatitis is still prevalent in Mongolia. Thus, the need for proper infection control is increasing in this country.
Cohort Studies ; Hepacivirus ; Hepatitis A virus ; Hepatitis A* ; Hepatitis B ; Hepatitis B virus ; Hepatitis C ; Hepatitis D ; Hepatitis Delta Virus ; Hepatitis Viruses ; Hepatitis* ; Humans ; Incidence ; Infection Control ; Liver Diseases ; Male ; Mongolia* ; Prevalence ; Risk Factors ; Superinfection

OBJECTIVEHepatitis Delt a Virus (HDV) antigen is widely used as a capture antigen in ELISAs for the identification of HDV infection; large amounts of recombinant HDV antigen with active antigenicity are required for this purpose.

METHODSReconstruct the gene of HDV antigen based on the bias code of Escherichia coli, the recombinant protein expresses by high-density fermentation with fed-batch feeding strategy, and purify by immobilized metal chromatography. The sensitivity and specificity of this antigen detect by ELISA method.

RESULTSThe expression of HDV antigen can reach 20% of the total cell mass in the soluble form. The recombinant HDV antigen can be conveniently purified (98%) by immobilized metal ion affinity chromatography (IMAC) using the interaction between a His-tag and nickel ions. Production of recombinant HDV antigen can reach 0.5 g/L under conditions of high-density cell fermentation. Applied to the diagnostic ELISA method, the recombinant HDV antigen shows excellent sensitivity (97% for IgM and 100% for IgG) and specificity (100% for IgG and IgM) for the detection of anti-HDV antibodies.

CONCLUSIONExpression and purification the recombinant HDV antigen as a candidate protein for application in a diagnostic ELISA for HDV infection. Large-scale production of the protein can be achieved using the high-density fermentation strategy.

Enzyme-Linked Immunosorbent Assay ; Escherichia coli ; genetics ; metabolism ; Fermentation ; Hepatitis D ; diagnosis ; immunology ; virology ; Hepatitis Delta Virus ; immunology ; Hepatitis delta Antigens ; immunology ; Recombinant Proteins ; genetics ; metabolism

Chronic hepatitis B affects 400 million people worldwide and is one of the leading causes of liver-related morbidity and mortality. All clinically available hepatitis B virus (HBV) drugs are nucleoside or nucleotide analogs that inhibit viral reverse transcriptase (RT) activity. Resistance to these HBV drugs has been widely reported, and is due to specific mutations in the viral RT domain. Therefore, the development of new, non-polymerase targeting anti-HBV agents is urgently needed. A potential drug target, the HBV receptor that mediates the viral entry process, has been recently identified using human primary hepatocytes, northern tree shrew (Tupaia belangeri) hepatocytes, and HepaRG cells. A transporter of bile acids, sodium taurocholate cotransporting polypeptide (NTCP), was identified as the receptor for HBV and hepatitis D virus, and the transport function of NTCP was correlated with HBV entry. Therefore, functional inhibitors of NTCP may inhibit HBV infection, and viral entry was blocked by several NTCP receptor-targeting compounds. The HBV receptor is an attractive target for development of entry inhibitors, and serves as a model for the mechanistic study of HBV entry and infection. This review will summarize the characteristics and clinical importance of NTCP, and will discuss the potential therapeutic use of NTCP inhibitors to prevent HBV entry.
Bile Acids and Salts ; Hepatitis B virus ; Hepatitis B* ; Hepatitis B, Chronic ; Hepatitis Delta Virus ; Hepatocytes ; Humans ; Mortality ; RNA-Directed DNA Polymerase ; Taurocholic Acid ; Tupaiidae

Chorinic hepatitis B virus (CHB) infection is a serious problem that affects over 300 million people worldwide and is highly prevalent in the Asia Pacific region. In the Philippines an estimate 7.3 million Filipinos or 16.7% of adults are chronically infected with HBV, more than twice the average prevalence in the Western Pacific region.

In view of the above, the Hepatology Society of the Philippines (HSP) embarked on the development of consensus statements on the management of hepatitis B with the primary objectives of standardizing approach to management, empowering other physicians involved in the management of hepatitis B and advancing treatment subsidy by the Philippine Health Insurance Corporation (PhilHealth).

The local guidelines include screening and vaccination general management, indications for assessment of fibrosis in those who did not meet treatment criteria. indications for treatment, on-treatment and post-treatment monitoring and duration of antiviral treatment. Recommendations on the management of antiviral drug resistance, management of special populations including patients with concurrent HIV or hepatitis C infection, women of child-bearing age (pregnancy and breastfeeding), patients with decompensated liver disease, patients receiving immunosuppressive medications or chemotherapy and patients in the setting of hepatocellular carcinoma are also included. However, the guidelines did not include management for patients with liver and other solid organ transplantation, patients on renal replacement therapy, and children.

The consensus statements will be amended accordingly as new therapies become available.

Hepatitis B ; Consensus ; Hepatitis B, Chronic ; Hepatitis B Virus ; Fibrosis ; Drug Therapy ; Carcinoma, Hepatocellular ; Liver Cirrhosis ; Hepatitis Delta Virus ; Hiv

BACKGROUND/AIMS: The aims of the present study were to determine the outcomes of inactive hepatitis B virus (HBV) surface antigen (HBsAg) carriers over a 10-year study period and to elucidate the HBV serological profile of their family members. METHODS: We retrospectively analyzed the medical files of inactive HBsAg carriers followed up at the Department of Infectious Diseases of Kocatepe University Medical Faculty Hospital between March 2001 and January 2011. RESULTS: In total, 438 inactive HBsAg carriers were enrolled in this trial. The follow-up period was 33.7+/-22.5 months (mean+/-SD). Anti-hepatitis-B surface antibody seroconversion occurred in 0.7% of cases, while chronic hepatitis B was found in 0.5%. The anti-hepatitis-D virus (HDV) status was evaluated in 400 patients and anti-hepatitis C virus (HCV) in 430. It was found that 1% and 0.2% were positive for anti-HDV and anti-HCV, respectively. HBV serology was investigated in at least 1 family member of 334/438 (76.3%) patients. The HBsAg positivity rate was 34.6% in 625 family members of 334 patients. A comparison of the HBsAg positivity rates in terms of HBV DNA levels in index cases revealed that HBsAg seropositivity rates were higher in family members of HBV DNA-negative patients than in family members of HBV DNA-positive cases (P=0.0001). CONCLUSIONS: The HBsAg positivity rate was higher in family members of inactive HBsAg carriers than in the general population; these family members therefore have a higher risk of HBV transmission. Furthermore, despite negative HBV DNA levels, transmission risk was not reduced in these patients, and horizontal transmission seems to be independent of the HBV DNA value.
Adult ; Antibodies/blood ; Carrier State ; DNA, Viral/analysis ; Family Health ; Female ; Follow-Up Studies ; Hepatitis B Antibodies/blood ; Hepatitis B Surface Antigens/*blood ; Hepatitis B virus/genetics/immunology ; Hepatitis B, Chronic/*diagnosis/transmission/virology ; Hepatitis Delta Virus/immunology ; Humans ; Male ; Middle Aged ; Retrospective Studies

Hepatitis viruses are most important cause of acute and chronic hepatitis. In past, hepatitis B virus was one of the major causes of acute hepatitis. Recently, around 60-70% of acute hepatitis is attributed to hepatitis A virus infection. In this article, we will discuss the route of hepatitis virus infection, how to prevent transmission of viral hepatitis and who should be immunized to each hepatitis viruses.
Hepacivirus ; Hepatitis ; Hepatitis A virus ; Hepatitis B virus ; Hepatitis Delta Virus ; Hepatitis E virus ; Hepatitis Viruses ; Hepatitis, Chronic ; Vaccination

OBJECTIVETo obtain high yield and good antigenic activity of HDV L-Ag and to detect different regional patients' sera to test the purified antigen's antigenicity.

METHODSHepatitis delta virus' sequence was obtained from Inner Mongolian patient by using RT-PCR and PCR methods, PET43a was used and His-tag was added at the HDV L-Ag 5' and 3' to construct the recombinant expression plasmid, transform the plasmid into host bacterium BL21 and induce it with IPTG. The expression supernatant was purified by saturated (NH4)2SO4 and affinity chromatography. The activity and antigenicity of the expressed product were analyzed by using EIA.

RESULTSComparison of results obtained with detection by using the expressed protein coated plate and ABBOTT Murex anti-Delta (total) of 15 positive and 10 negative sera, the consistency was good (100%).

CONCLUSIONEIA proved that the purified antigen had good antigenicity, no serological difference was found in detection between different region's sera, therefore the purified delta antigen may be useful in diagnostic and other research.

Amino Acid Sequence ; China ; Cloning, Molecular ; Electrophoresis, Polyacrylamide Gel ; Escherichia coli ; genetics ; Gene Expression ; Hepatitis D ; blood ; virology ; Hepatitis Delta Virus ; genetics ; immunology ; isolation & purification ; Hepatitis delta Antigens ; blood ; genetics ; metabolism ; Humans ; Molecular Sequence Data ; Plasmids ; genetics ; Recombinant Proteins ; immunology ; metabolism

BACKGROUNDTo construct the pRSETB-HDAg recombinant expression plasmid and to obtain soluble hepatitis D virus antigen with high biological and antigenic activity.

METHODSHDAg gene fragment was inserted into fusion expression pRSET B vector that includes T7 promoter and a polyhistidine tag. The recombinant plasmid was transformed into host bacterium BL21 after induction with IPTG. The expression supernatant was purified by chelating affinity chromatography and the recombinant HDAg antigenic activity was detected by EIA.

RESULTSEIA detection using the recombinant HDAg showed strong positive reaction with hepatitis D patients sera. The positive rates of the EIA, compared with HDAg from USA and Hua Mei EIA kit in detecting 26 cases of anti-HDV positive reference sera, were 100%, 96.15% and 100%, respectively.

CONCLUSIONRecombinant plasmid for HDAg with good antigenicity was successfully constructed and could be used as hepatitis D antibody detection reagent.

Electrophoresis, Polyacrylamide Gel ; Escherichia coli ; genetics ; Gene Expression ; Hepatitis Delta Virus ; genetics ; immunology ; metabolism ; Hepatitis delta Antigens ; genetics ; immunology ; metabolism ; Immunoenzyme Techniques ; Recombinant Proteins ; immunology ; metabolism

OBJECTIVETo clarify the relationship between fatal severe form hepatitis occurred during chronic hepatitis B and superinfections of hepatitis A, C, D or E virus as well as hepatitis B e system status and to adopt corresponding measures to reduce the mortality of chronic hepatitis B.

METHODSThis study detected the superinfections with hepatitis A, C, D or E virus and hepatitis B e system status in 219 patients with fatal severe form hepatitis occurred during chronic hepatitis B by enzyme linked immunosorbent assay.

RESULTSThe superinfections with hepatitis A, C, D or E virus were found in 1.4% (3/219), 9.6% (21/219), 1.8% (4/219) and 30.1% (66/219) of the patients, respectively, altogether 42.9% (94/219); hepatitis E was prominent and steady in superinfection rate in recent ten years. The causes of 57.1% (125/219) patients were not clear. The positive rate of HBeAg and anti-HBe were 17.0% (16/94) and 54.2% (51/94) in the group of superinfections with hepatitis A, C, D or E virus; and were 27.2% (34/125) and 47.2% (59/125) in the group with unknown causes, respectively.

CONCLUSIONThese results suggested that the patients with superinfections reached 42.9% (94/219), and the superinfections may be a part of causes of fatal severe form hepatitis, and the mortality of chronic hepatitis B may be decreased by strict food sanitation and use of safe blood products. There were no significant relation between hepatitis B e antigen seroconversion and the fatal severe form hepatitis occurred during chronic hepatitis B.

Adult ; DNA, Viral ; blood ; genetics ; Female ; Hepacivirus ; genetics ; physiology ; Hepatitis A virus ; genetics ; physiology ; Hepatitis B Core Antigens ; blood ; Hepatitis B Surface Antigens ; blood ; Hepatitis B e Antigens ; blood ; Hepatitis B virus ; genetics ; immunology ; physiology ; Hepatitis B, Chronic ; blood ; mortality ; virology ; Hepatitis Delta Virus ; genetics ; physiology ; Hepatitis E virus ; genetics ; physiology ; Host-Pathogen Interactions ; Humans ; Male ; Middle Aged ; Superinfection ; virology ; Survival Rate