Transmission of hepatitis D virus between spouses: A longitudinal study of the first reported Canadian case.
In chronic hepatitis B (CHB), hepatitis D virus (HDV) superinfection can lead to acute liver failure. The incidence of HDV superinfection is unknown, but is often detected in immigrants from HDV endemic countries. In this report, we characterize long-term clinical and virological outcomes in a hepatitis B virus (HBV) infected carrier before and after HDV superinfection, acquired from their spouse having HBV/HDV co-infection. A 38 year-old Mongolian male with CHB on anti-HBV therapy developed acute liver failure following HDV superinfection. Although he recovered, avoiding the need for liver transplant, HDV serological and molecular markers of infection persisted for the subsequent 16-month follow-up period, suggesting the development of CHB/HDV co-infection. The source of his HDV was from his wife of 10 years, a 34-year old Mongolian female known to have inactive CHB/HDV co-infection but who was not on anti-HBV therapy. Phylogenetic analysis of the complete HDV genome from the couple showed >99% similarity, with post-transmission longitudinal sequence revealing specific nucleotide substitutions between both spouse's HDV genome sequences. This study highlights the ongoing risk of HDV superinfection due to long-term co-habitation or sexual transmission in CHB patients. The fact that transmission occurred after almost a decade of marriage may be due to host immune or environmental factors that created a more favorable condition for transmission.
Viral Hepatitis and Bloodborne Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington St., Winnipeg, Manitoba, R3E 3R2, Canada.
Carla
C
Osiowy
Viral Hepatitis and Bloodborne Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington St., Winnipeg, Manitoba, R3E 3R2, Canada.
Anton
A
Andonov
Provincial Laboratory for Public Health, 3030 Hospital Dr. NW, Calgary, Alberta, T2N 4W4, Canada.
Kevin
K
Fonseca
Viral Hepatitis and Bloodborne Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington St., Winnipeg, Manitoba, R3E 3R2, Canada.
Ken
K
Swidinsky
Viral Hepatitis and Bloodborne Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington St., Winnipeg, Manitoba, R3E 3R2, Canada.
Elizabeth
E
Giles
Division of Gastroenterology, Zeidler Ledcor Centre, University of Alberta, Edmonton, Alberta, T6G 2X8, Canada.
Andrew
A
Mason
Calgary Liver Unit, Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr. NW, Calgary, Alberta, T2N 4Z6, Canada.
Carla S
CS
Coffin
Acute liver failure; CHB, chronic hepatitis B infection; HBV, hepatitis B virus; HDV, hepatitis D virus; Hepatitis B; Hepatitis D; IFN, interferon; IU, international units; LSM, liver stiffness measurement; PCR, polymerase chain reaction; Spousal transmission; Superinfection; TDF, tenofovir dixoproxil fumarate; TND, target not detected; Tenofovir; kPA, kilopascals; qHBsAg, quantitative HBsAg