Hepatite D no Brasil e Amazônia Internacional: uma revisão sobre aspectos virológico, epidemiológicos, diagnóstico e tratamento

Abstract

About 74 million people are infected with the hepatitis D virus (HDV) worldwide. Given the endemicity in some regions of Brazil and the international Amazon, HDV infection is considered an important public health problem in these regions. In Brazil, HDV has a higher incidence in the Brazilian Amazon, mainly in the Juruá, Solimões and Purus river basins, in the state of Amazonas, as well as in some countries of the international Amazon, such as Venezuela, Colombia and Peru. The objective of this study was to carry out a bibliografic review and analyze the main historical, epidemiological, diagnosis and treatment of the hepatitis D virus in Brazil and in the International Amazon. The electronic databases selected for the search were: National Library of Medicine National Institutes of Health (PubMed), CAPES Journal Portal, Springer, Latin American and Caribbean Health Sciences Literature (LILACS), Scientific Electronic Library Online (SciELO), epidemiological bulletins, theses and dissertations. The data were stored in a database, in a Microsoft Excel spreadsheet, later organized according to the theme and classified in ascending order of the year of publication. We obtained and analyzed 163 publications targeting HDV infection, published between 1977 and 2022. Of these, 47% correspond to the epidemiology category. The year 2014 was the year with the highest volume of publication/year, with 13 articles. Among the parameters analyzed, it was found that the high endemicity of HDV both in the Brazilian and international Amazon is associated with the sociodemographic situation and the heterogeneous pattern of the population, since the highest prevalence is found mainly in the lower class population, in riverside communities, indigenous populations and in young males. In Brazil, the highest occurrence is in the North region, with 73.7% of cases (from 2000 to 2021), according to publications, the international Amazon has significant rates, such as in communities in Venezuela, 216 people with 34% contaminated, in Colombia with 23 people with 43.5% co-infected and in Peru 870 inhabitants of a village with 39% of these carriers of HDV. As for genotypic diversity, both in the Brazilian and international Amazon, genotype 3 prevails in 100% of the analyzed samples. Regarding the laboratory diagnosis of hepatitis D, the most used tests are serological (anti-HD IgG, total anti-HD), biochemical, immunohistochemical, molecular (rt-PCR and real time PCR), and rapid test. As for the treatment of hepatitis D, Interferon alfa 2nd and/or a nucleo(t)ide analogue (tenofovir or entecavir) are used.