Hepatitis Delta Virus (Hdv) In Hiv/Hbv Co-Infected Patients In Ghana

ABSTRACT Within persons infected with HIV worldwide, almost 10% have chronic HBV infection, and about 6% of all HBV infected patients are co-/superinfected with HDV, resulting in accelerated progression of hepatitis towards end stage liver disease. Even though within HIV/HBV infected patients, an increase in HDV infection has been observed, there is inadequate information on HDV prevalence as well as virologic profile in Ghana. This study sought to determine the presence of HDV in HIV/HBV co-infected patients in Ghana. This was a longitudinal purposive study which enrolled 113 patients, who have been co-infected with HIV and HBV, attending clinic at Korle-Bu Teaching Hospital (KBTH) in Ghana. Patient demographic information was obtained using a questionnaire, and 5 mL whole blood collected at two-time points (baseline and 4-6 months afterwards). The sera obtained were tested to confirm the presence of HIV, HBV antibodies/antigens and HBV DNA. Antibodies and viral RNA were also determined for HDV with respective serological and molecular assays. Amplified HBV DNA and HDV RNA were sequenced with the Sanger method and sequence reads analyzed using Sequencher software version 2.3. Phylogenetic analysis was carried out with references from the GenBank to establish the genotypes using the MEGA X software. Out of 113 samples tested, 63 (55.7%) were females and 50 (44.25%) were males. Patients enrolled in this study were within the age range of 24 to 73 years, with a median age of 45 years. A total of 100 (88.5%) samples had detectable HBV surface antigen (HBsAg), and 32/113 had detectable HBV DNA. Nucleotide sequences were obtained for 15 samples, and phylogenetic analysis showed the circulating strains to be HBV genotype E. Of 13 samples that were HBsAg unreactive, 4 (30.8%) had detectable HBV DNA and suggest the presence of an occult infection. HDV was detected in four samples and giving a prevalence of 3.54% in the HIV/HBV cohort used for the study. Two of the HDV positive samples sequenced were HDV genotype 1. In summary, the data suggest the presence and circulation of HDV and occult HBV infection in HIV patients co-infected with HBV in Ghana. The occurrence of occult HBV infection and HDV in the study population is supported by other research studies, and makes it imperative to look out for the presence of HDV and occult HBV in patients co-infected with HIV/HBV.