HEPATITIS DELTA PREVALENCE AND CLINICAL ...

HEPATITIS DELTA PREVALENCE AND CLINICAL EXPRESSION IN AN IMMIGRANT POPULATION IN ITALY G. Colucci1, M. Colombo1, G. Lunghi2, P. Bono2, S. Fadelli3, M. Adamoli3 , D. Aurelio3 , M. Abbruzzese M3, Romeo R1 Division of Gastroenterology and Hepatology1 and of Laboratory Medicine2 Fondazione Ca’ Granda, Policlinico, Milan; Poliambulatorio Opera San Francesco per i Poveri (OSF)3Milan, Italy

Results

Background

Starting September 2014, 187 migrants originating from North Africa (10%), Eastern Europe Hepatitis delta virus (HDV), a defective agent coinfecting 5% of chronic hepatitis B virus (HBV) carriers, has recently regained the interest of the scientific community because of its increasing prevalence and morbidity rates, particularly in developing countries. In this respect, we started a screening program at one of the largest NGO clinic in Italy, Opera San Francesco (OSF) in Milan

where

patients

are

mainly

(48%), Central and South America (33%) and Asia (9%) have been screened (Fig. 1, 3). 18 patients resulted HBsAg positive (9.6%) of whom 2 patients with compensated cirrhosis tested also IgG and IgM anti-HDV positive (11%) but HDV RNA undetectable (< 30 copies/ml) and are currently treated with Entecavir,

300 mg/die (Fig. 2). The detection

and quantitative

determination of HBV DNA and the quantitative determination of HBsAg are currently still in process, as well as a thorough investigation and assessment of each positive individual’s familiar, personal and pathological history.

illegal immigrants or refugees lacking health insurance ETHNICAL DISTRIBUTION EGYPT 3%

coverage and often proper housing accommodation.

OTHERS' 15%

BULGARIA 3%

Aim

ROMANIA 28%

SENEGAL 3%

•To assess the incidence and prevalence of HDV infection in a large population of illegal immigrants who have no access to health care and offer them appropriate support

MAROCCO 5%

EL SALVADOR 17%

BRASIL 5% PERU' 6%

and counceling.

UKRAINE 15%

Fig. 1

•To assess the size of the HDV reservoir and raise awareness in the medical community and in the public health authorities.

100% 98%

Methods

96% 94% POS 92%

Using commercially available tests ( Diapro Srl, Sesto S.

NEG

90% 88%

Giovanni, Italy) HBV and HDV infections were sought in consecutive, unselected individuals, independently on their

86% 84%

Fig. 2

82% HDV

health status.

HDV/HBV

Following HBsAg and IgG and IgM anti-HDV detection,

HBV

NAZIONALITA' PZ POSITIVI HBsAg

positive patients underwent HBVDNA and HDV RNA testing EGITTO 8%

whereas the screening tests were offered to their close relatives. Quantitative HBsAg determination is currently

ALBANIA 8% ROMANIA 42%

EL SALVADOR 8%

SENEGAL 17%

underway (ARCHITECT HBsAg Quantitative. Abbott SpA, MAROCCO 8%

Roma).

TUNISIA 9%

Fig. 3

CONCLUSIONS This interim analysis suggests a high HBsAg carrier state prevalence (9.6%) and an HDV co infection rate of 11.6% among illegal immigrants, slightly lower than that recently reported, particularly in east Europe, but probably better reflecting the situation of the general population in these countries as we did not apply any patients selection. By the time this screening project is concluded it will be the largest ever carried out in not selected illegal immigrants from high endemic countries and will add new information on the actual HBsAg and HDV prevalence in these areas. This may contribute to the improvement of policies of containment and management of HDV infection as well as to the development of new therapeutic strategies against HDV. Dr. Giuseppe Colucci, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano Il sottoscritto dichiara di non aver avuto negli ultimi 12 mesi conflitto d’interesse in relazione a questa presentazione che non contiene discussione di farmaci in studio o ad uso off-label