Hepatitis delta virus propagation enabled by hepatitis C virus—Scientifically intriguing, but is it relevant to clinical practice?

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Abstract

In vitro cell culture experiments and animal models have demonstrated that hepatitis delta virus (HDV) can theoretically propagate being enveloped by human pathogenic viruses other than hepatitis B virus (HBV), namely hepatitis C virus (HCV) and dengue virus. However, the clinical relevance of these findings and whether HDV replication occurs in real-world hepatitis B surface antigen (HBsAg)–negative HCV patient cohorts remain unknown. To this aim, we analysed 323 HCV-RNA–positive and HBsAg-negative sera for the presence of HDV-RNA and anti-HDV antibodies (anti-HDV). All 323 (100%) samples were negative for HDV-RNA. Interestingly, 8/316 samples tested positive for anti-HDV. The HBV serology of these eight patients showed a positive result for HBV core antibodies (anti-HBc) indicating a seroconversion of an acute HBV infection in the past. None of the anti-HBc–negative patients were positive for anti-HDV. Our results indicate a distinctly low probability of replicative HDV infection in HCV mono-infected patients in Germany. Current German clinical guidelines rightly recommend performing HDV screening only in HBsAg-positive patients. However, larger studies on this subject should be performed in regions that are endemic for chronic HBV/HDV as well as HCV infections.

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Pflüger, L. S., Schulze zur Wiesch, J., Polywka, S., & Lütgehetmann, M. (2021). Hepatitis delta virus propagation enabled by hepatitis C virus—Scientifically intriguing, but is it relevant to clinical practice? Journal of Viral Hepatitis, 28(1), 213–216. https://doi.org/10.1111/jvh.13385

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