HDV in Greenland. Henrik Krarup, MD, Phd Section of Molecular Diagnostics Aalborg University Hospital Denmark. Aalborg Hospital NORTH DENMARK REGION
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1 HDV i Greelad Herik Krarup, MD, Phd Sectio of Molecular Diagostics Aalborg Uiversity Hospital Demark
2 Disclosures Noe relevat to this talk
3 Greelad Achorage Greelad DK Populatio i Greelad Idigeous populatio (80 %)
4 Greelad ilad ice
5 Sisimiut, Greelad 2017
6 Sisimiut, Greelad 2017
7 Sisimiut, Greelad 2017
8 Sisimiut, Greelad 2017
9 Sisimiut, Greelad 2017
10 Hepatitis B i Greelad 1973: 2900 cases screeed, 7.1 % HBsAg positive 1985: 11.5 % HBsAg positive i a screeig i Sisimiut especially i the group of years old 1987: 6170 cases screeed, 7.8 % HBsAg positive 1998: 2709 cases screeed, 6.4 % HBsAg positive Chief Medical Office Greelad 2007 P. Skihøj Am J Epidemiol 1974 M. Børrese Phd afhadlig 2010
11 Beig course of log-stadig hepatitis B virus ifectio amog Greelad Iuit? Greelad is a high edemic area of hepatitis B ifectio (HBsAg > 7%) Most trasmissio of hepatitis B virus (HBV) i Greelad takes place before the age of 20 years Liver cirrhosis ad liver cacer (HCC) are less frequet tha expected Util September 2010 HBV vacciatio was ot part of the atioal ifat immuizatio programme i Greelad
12 Past or preset HBV ifectio amog years old % of populatio with hepatitis B % Sisimiut 30 % Itilleq 3 % Nuuk 28 % 30 % Tasiilaq Settlemets Past Preset
13 Distributio of HBV-geotypes i Greelad 17% A 44% D 1% C 38% B Number of patiets 156
14 Distributio of HBV geotypes i Eastgreelad B ad D 2% D 8% B 90% Krarup H, Aderse S et al. SJG 2008
15 Hepatitis D virus Features Ow separate geus, Deltavirus The smallest kow aimal virus Sigle-straded, circular, egative RNA geome 1700 ucleotides, which ecodes a sigle structural protei, HDAg Ecapsidated by HBsAg Uses the host RNA polymerase for replicatio
16 Hepatitis D virus Cliical features 4 Fulmiat hepatitis more frequet i HBV-HDV ifected patiets tha i HBV ifected patiets aloe 4 Presece of HBV-DNA ad HDV-RNA is associated with a lower HBV remissio rate 4 Trasmissio is either simultaeous co-ifectio with HBV or superifectio of a HBsAg carrier 4 Super-ifectio with HDV has a higher risk of chroicity tha HDV coifectio
17 Chroic hepatitis D i Greelad
18 Itilleq
19 Outbreak of HDV i Itilleq 31 of 115 ihabitats were HBsAg positive 21 persos were ati-delta (IgG) positive 14 persos were HDV-RNA positive 5 childre had serocoverted to ati-delta positive withi oe year The highest levels of ALT were foud i HDV-RNA positive persos, idicatig active HDV ifectio Børrese et al, JVH 2010; 17:
20 HDV virology Itilleq ad Sisimiut Sice 2010 i all 92 HBsAg positive patiets have bee tested for HDV-RNA. 34 (M/F; 19/15) are HDV-RNA positive I this period 3 patiets serocoverted ad became HDV-RNA positive Oe 28 year-old patiet cleared the ifectio Two patiets a 13 ad a 41 years old became chroically ifected No systematic testig for HDVAb has bee doe
21 Hepatitis D virus Cliical ad virologic features AST/ALT (mea, high, low) 104 (42-271) / 214 (64-549) HDV positive patiets have HBV geotype D ad HDV clade 1 (geotype 1) Liver biopsi have bee performed i 24 of 34 HDV ifected idividuals
22 Distributio of viral load Percetage HBV-DNA HDV-RNA Log Viral load copies/ml
23 Liver biopsy results from 24 patiets Percetage Metavir score
24 I coclusio I Greelad approximately 4000 persos have chroic HBV ifectio ad are as such at risk of gettig HDV I cotrast to HBV moo ifected patiets, patiets with dual ifectio HBV / HDV have sigificat fibrotic chages
25 25 EEJ
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