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THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 3 | 8 and confessional structures in the city of Ouagadougou. The positive diagnosis of B-delta infection was made on biological grounds: • The serological analyses: HBsAg, HBeAg, anti- HBeAb were performed by the following techniques: ELISA MiniVidas BioMérieux and DetermineTM (Abbott) and total anti-Delta antibodies were tested with the ELISA technique (Diasorin ® ETI-AB-MAK2). • HBV viral load (DNA) was performed by real-time PCR (Roche CobasTaqMan with a detection limit of 10 IU/mL and a linearity range of 10 - 1,000,000,000 IU/mL (1-9 log). • VHD viral load (RNA): the detection and quantification of delta virus RNA was performed by gene amplification (RT-PCR) with a detection limit of 100 IU/mL and a linearity range of 100-100,000,000 IU/mL (2-8 log). Additional tests and treatment were paid for by the patient. Transaminases were monitored monthly, then quarterly and semi-annually. In each patient, whether on treatment or not, at least one control B viral load was performed. Only one patient was able to achieve a control D viral load. Complete virological response was defined by an undetectable B viral load (HBV-DNA) and D viral load, and biochemical response by normalisation of transaminases. Results A total of 499 patients were screened for the delta virus and 11 were seropositive or 2.2% of this study population. The mean age of the patients was 42.5 ±7.9 years with extremes of 30 and 55 years. Seven patients were over 40 years of age. Our series consisted of 4 women and 7 men. The sex ratio was 1.75. Of the eleven patients, three had a history of jaundice and one had a history of surgery for choriocarcinoma. The other seven had no known history of jaundice. Jaundice was the circumstance of HBV discovery in three patients. In three others, the discovery was incidental during a health check-up and one case was discovered during the follow-up of haematemesis. One patient was icteric on clinical examination. This examination was normal in the other 10 patients. The dates of discovery of HBsAg, delta serology and HDV-RNA were not the same, table 1 gives us the different years in which these tests were carried out.. Table 1: Study flow diagram Distribution of patients according to dates of HBsAg, delta serology and HDV-RNA discovery Year of HBsAg discovery Year of delta serology By Year of completion of the HDV-RNA Patient 1 2009 2012 2017 Patient 2 2008 2015 2016 Patient 3 2008 2012 2015 Patient 4 2006 2006 Patient 5 2013 2014 2014 Patient 6 2016 2016 2016 Patient 7 2013 2013 2014 Patient 8 2009 2014 2015 Patient 9 1994 2014 2014 Patient 10 2011 2013 2013 Patient 11 2016 2017 2017 HBsAg quantification was performed in 09 patients (81.8%) with a mean value of 5278 IU/mL and extremes of 246 and 13000 IU/mL. All patients were HBeAg negative and HBeAg positive. The B viral load was performed in all patients. Nine were detectable (81.8%) and two were undetectable (18.2%). The mean viral load value was 760193 IU/mL (5.88 log) with extremes of 86 (1.93 log) and 3782000 (6.57 log) IU/mL. The D viral load was performed in ten out of eleven patients (90%). It was detectable in 06 patients (60%) and undetectable in the other 04 (40%). The results of the different viral loads are presented in Table 2. Table 2: Correlation between delta viral load and B viral load HBV DNA (IU/mL) VHD-RNA (IU/mL) Detectable Undetectable Detectable Undetectable Patient1 285 15 500 Patient 2 385 51 746 179 Patient 3 3 782 000 <100 Patient 4 3 056 000 <100 Patient 5 260 Patient 6 < 10 >10 000 000 Patient 7 1702 66 500 000 Patient 8 < 10 < 100 Patient 9 86 48 780 979 Patient 10 175 1 140 000 Patient 11 846 < 100 Abdominal ultrasound findings were collected in 10 patients (91%). Liver ultrasound was normal in 06 patients and showed signs of cirrhosis (dysmorphic liver with cirrhotic appearance) in 2 cases. Steatosis was found in one patient. Upper GI endoscopy was performed in 03 patients. Esophageal varices grade II were observed in 01 patient. In the other two, upper GI endoscopy was normal. The level of liver fibrosis was investigated by histology or non-invasive fibrosis tests. The different results are presented in table 3. Table 3: Distribution according to histology and non- invasive test results Histology FibroMètre ® (FibroMeter ® ) FibroTest FibroScan ® (kpa) Patient 1 - - - - Patient 2 A3F3 - - 15 Patient 3 - A2F2 - - Patient 4 - - - - Patient 5 - A0F0 - - Patient 6 - A2F3 - - Patient 7 - A3F3 - - Patient 8 - A1F1 - 5,2 Patient 9 - - - - Patient 10 - A2F1 - - Patient 11 A3F4 - A1F3F4 11,8 Total patients 02 06 01 03 REVIEW The result of the biological tests performed by the patient ar presented in tabl 4. Table 4: Distribution according to biological characteristics of patients Reviews Minimum value Average value Maximum value Total patients Prothrombin rate (%) 85 59 100 09 Albumin (g/l) 40.8 30 48 05 ASAT (IU) 202,7 13 2269 11 ALAT (IU) 270 08 2403 11 White blood cells (/mm3) 6194 3516 14000 09 Haemoglobin (g/dl) 13 9,7 16 09 Platelets (/mm3) 155000 48000 233 00 09 Alpha fetoprotein (IU/ml) 3.4 1 9 04 Of the 11 patients, 06 were treated against HBV. Of these, 01 patient was treated against HDV. The cirrhotic patient with oesophageal varices presented three episodes of haematemesis and received four sessions of oesophageal variceal ligation. The average duration of treatment was 4.5 years ith extremes of 04 months and 11 years. One patient had a treatment duration of 04 months. The other patients had a treatment duration ≥ 3 years. The biological evolution under treatment is presented in Table 5. Table 5: Distribution of patients according to virological and biochemical results Treatment Duration of t eatment HBV DNA (IU/mL) AST (IU/ mL) ALAT (IU/ mL) Detectable Undetectable Patient 1 TDF* 04 years < 10 53 59 Patient 2 IFN-peg* 04 years 45 54 52 Patient 3 TDF 03 years < 10 20 10 Patient 4 TDF 05 years < 10 31 50 Patient 5 TDF 04 months 82 104 Patient 6 TDF 11 years < 10 28 15 TDF* : Tenofovir 300 mg/d, IFN-peg*: Pegylatedinterferon The patient treated with IFN-peg for 58 weeks was 39 years old and showed improvement in ALT (from 80 to 52 IU/ML), HDV-RNA (from 7.7 to 5.7 log) and HBV-DNA/ IU/mL (385 to 45 IU/mL). Discussion It is estimated that 5-10% of HBsAg carriers are co- infected or superinfected with HDV worldwide8. In the present study, the prevalence of B-delta infection among chro ic B virus carriers was 2. %. This rate is close to th t (3.38%) found by Sawadogo and al in a 2 6 study of 177 HBsAg positive blood donors in Bobo-Dioulasso 9 . In Senegal, Vray and al found similar results among blood donors: 3.2% 10 . However, our prevalence is higher than that found by Méda and colleagues 7 in 2010 in the general population of Burkina Faso, which was 0.10%. We can note that the prevalence of delta infection in our study is very low compared to African series. Thus in Mauritania the prevalence was 39% and 33% respectively in 2010 and 2012 11 , in Niger 29% 12 , Cameroon: 17.6% 5 , in Benin among pregnant women: 11.4% 13 , in Ghana: 11.3% in 2014 14 , in North Cameroon: 7.3% 15 and Djebbi in Tunisia who found a prevalence of HDV of 6.8% amon 176 asymptomatic HBV carriers 16 . It sh uld be oted that in France, v ry high pr valences were n ted in 1980 (70% of drug addicts and 15% of homosexuals) in contrast to recent studi s which f und a prevalence of 4% in the general population 17 . In T iwan, rates of 74.4%, 43.9%, 11.4%, 11.1% and 4.4% w re respectively fou d in HIV positive drug us rs, HIV negative drug users, homosexual wom (Men), HIV inf cted heterosexual women and the general HBsAg positive population 18 . These results show that, although the hepatitis delta virus circulates in Burkina Faso, its prevalence remains low despite a relatively high prevalence of HBV: 9.1% 7 . The prevalence of B-delta infection is related to a number of epidemiological factors including family history, history of invasive care and risk behaviours (homosexuality, intravenous drug use) 19,20,21 . In our series, we did not find an explanation for this prevalence which is low (2.2%) compared to other African series. The mean age of the delta-positive patients was 42.5 years +/- 7.9 years. The age range above 40 years was the most representative, as seven patients in our series were over 40 years old. In Burkina Faso, Sawadogo et al found a much lower average age (22 years) than in our study. However, our results are comparable to those of Mansour in Mauritania with an average age of 41±11.5 years and El Gorachi in Mauritania (46 ±11.5 years) 22,23 . According to Mansour, the presence of Ac-anti-delta was associated with age and sex. However, according to Moatter 20 , HDV can infect at any age and we did not find any other studies showing a predilection for delta infection according to age. The gender distribution of patients in our study shows a slight male predominance. The sex ratio was 1.75. This slight male predomina ce has als been reported in other studies cond cted in Algeria in 2008 7 and in P kistan i 2007 20 . This may be explained by the fa t that HBV becomes chronic more often in men than in omen. Howev r, while the redomi ance was male in the p evious series, in the Djebbi et l study the sex ratio as 0.2 17 . Hepatitis B was discover d during th asses ment of jaundice in three patients. In three others, the di covery was fortuitous during a health ch ck-up and one case was discovered during the follow-up of a haematemesis. his result shows that HBV screening is not done systematically in the population, but on the occasion of a symptomatology that is generally a complication of hepatitis B. The clinical examination was normal in 10 patients. Cirrhosis was found in three patients, two of whom were confirmed by PBH, and severe fibrosis (F3) assessed by the FibroMeter® was found in 02 pat nts. The FibroScan® performed on three patients showed a hepatic elasticity of 5.2 kpa; 11.8 kpa and 15 kpa. The only patient who had a clinical argument (h ematemesis) did not undergo PBH or non-invasive evaluation of fibrosis. These observations show that despite a normal clinical examination, a patient with HBV and/or HDV can develop complications (in particular cirrhosis) and the patient will most often only come to see a clinical sign of decompensation of cirrhosis, which is the most frequent stage of discovery of chronic viral hepatitis in our context as reported in the literature. These findings reinforce the importance of early detection and management of chronic hepatitis B before the stage of complications. In principle, HBsAg testing should be systematically performed during routine consultations and any health check-up in our context, REVIEW