Hepatitis D virus infection, cirrhosis and hepatocellular carcinoma in The Gambia.

Abstract

Hepatocellular carcinoma (HCC) incidence is high in The Gambia, and hepatitis B virus (HBV) infection is the main cause. People coinfected with HBV and hepatitis D virus (HDV) have an even greater risk of HCC and cirrhosis. Using a new HDV quantitative microarray antibody capture (Q-MAC) assay, we evaluated the association between HDV infection and HCC or cirrhosis among participants in The Gambia Liver Cancer Study. In this case-control study, cases had HCC (n = 312) or cirrhosis (n = 119). Controls (n = 470) had no clinical evidence of liver disease and normal serum alpha-foetoprotein. Participants were previously tested for hepatitis B surface antigen (HBsAg); we tested HBsAg+ specimens by HDV Q-MAC, western blot and RNA assays. We evaluated separate cut-offs of the Q-MAC assay for predicting anti-HDV and RNA positivity. Q-MAC correctly identified 29/29 subjects who were western blot-positive (sensitivity = 100%, specificity = 99.4%) and 16/17 who were RNA-positive (sensitivity = 94.1%, specificity = 100%). Compared to controls, cases more often had HBV monoinfection (HBsAg+/HDV RNA-; 54.1% vs 17.0%; odds ratio [OR] = 6.28; P < 0.001) or HBV-HDV coinfection (HBsAg+/HDV RNA+; 3.9% vs 0%; P < 0.001). Risk estimates (for HCC or cirrhosis) based on HDV antibody status and adjusted for covariates (demographics, alcohol, smoking, body mass index, anti-HCV and aflatoxin B1 exposure) yielded consistent results for both HBV monoinfection (adjusted OR = 8.29; 95% confidence interval = 5.74-11.98) and HBV-HDV coinfection (adjusted OR = 30.66; 95% confidence interval = 6.97-134.95). In this Gambian population, HDV Q-MAC had high sensitivity and specificity for both anti-HDV and HDV RNA. HDV infection contributed to the high risk of HCC in The Gambia.

• Authors: Parag Mahale, Peter Aka, Xiaohua Chen, Ruth M Pfeiffer, Ping Liu, Sarah Groover, Maimuna Mendy, Ramou Njie, James J Goedert, Gregory D Kirk, Jeffrey S Glenn, Thomas R O'Brien
• Journal: Journal of viral hepatitis (J Viral Hepat) Vol. 26 Issue 6 Pg. 738-749 (06 2019) ISSN: 1365-2893 [Electronic] England
• PMID: 30661282 (Publication Type: Journal Article, Research Support, N.I.H., Intramural)
• Copyright: © 2019 John Wiley & Sons Ltd.

Topics

• Adult
• Carcinoma, Hepatocellular (epidemiology, virology)
• Case-Control Studies
• Coinfection (complications, epidemiology, virology)
• Female
• Gambia (epidemiology)
• Hepatitis B (epidemiology)
• Hepatitis D (complications, epidemiology)
• Hepatitis Delta Virus (immunology)
• Humans
• Incidence
• Liver Cirrhosis (complications, epidemiology, virology)
• Liver Neoplasms (epidemiology, virology)
• Male
• Middle Aged
• Tertiary Care Centers