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THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 3 | 9 The results of the biological tests performed by the patients are presented in table 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 233000 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 with 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 treatment 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 chronic B virus carriers was 2.2%. This rate is close to that (3.38%) found by Sawadogo and al in a 2016 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% among 176 asymptomatic HBV carriers 16 . It should be noted that in France, very high prevalences were noted in 1980 (70% of drug addicts and 15% of homosexuals) in contrast to recent studies which found a prevalence of 4% in the general population 17 . In Taiwan, rates of 74.4%, 43.9%, 11.4%, 11.1% and 4.4% were respectively found in HIV positive drug users, HIV negative drug users, homosexual women (Men), HIV infected 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 predominance has also been reported in other studies conducted in Algeria in 2008 7 and in Pakistan in 2007 20 . This may be explained by the fact that HBV becomes chronic more often in men than in women. However, while the predominance was male in the previous series, in the Djebbi et al study the sex ratio was 0.2 17 . Hepatitis B was discovered during the assessment of jaundice in three patients. In three others, the discovery was fortuitous during a health check-up and one case was discovered during the follow-up of a haematemesis. This 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 patients. 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 (haematemesis) 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. 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