Hepatitis D research highlights need for increased screening

Research from the Public Health Agency of Canada (PHAC)’s National Microbiology Laboratory (NML) is offering new insights into how common the hepatitis D virus is in Canada and who is infected.

Scientists from the NML are working with the Canadian HBV (Hepatitis B Virus) Network, a group of physicians and scientists from across the country, to understand risk factors and outcomes of hepatitis D. The NML is Canada’s reference laboratory for hepatitis viruses, which means that provincial laboratories send samples to the NML to verify their results and do quality assurance tests. The NML is one of the only labs in the country that provides hepatitis D testing.

What is hepatitis?

Hepatitis is inflammation of the liver caused by viruses (viral hepatitis) or other factors. Hepatitis D is considered a satellite virus (a virus that depends on another virus to be able to infect a person). In this case, hepatitis D is a satellite virus of hepatitis B, meaning that a person must already be infected with hepatitis B in order for hepatitis D to cause an infection. Hepatitis D can lead to cirrhosis (scarring of the liver) and liver cancer, much more aggressively than hepatitis B or C.

Why understanding the numbers matters

With the development of new therapies for hepatitis D, knowing how many people are infected is necessary to properly target and fund meaningful interventions that help save lives and prevent people from developing life-threatening conditions, such as cancer, caused by hepatitis. These interventions include a new drug, bulevirtide, that is showing promise in treating Hepatitis D and for which approval is being sought in North America.

“The screening and testing of hepatitis D infected populations is crucial to ensuring physicians can provide appropriate treatment, care and support,” says Dr. Carla Osiowy, Chief, Viral Hepatitis and Bloodborne Pathogens at the NML. “Increased awareness also means physicians can provide information to patients such as how to protect themselves from being infected or how to prevent further transmission to other people.”

The number of hepatitis D cases worldwide is unknown due to a lack of standardized testing and routine screening for the virus. However, the NML is gathering Canadian data in order to help physicians and researchers better understand national and international numbers. The NML is increasing global public health awareness by publishing and presenting their findings at medical meetings. They are also working with the Canadian HBV Network and other educational/advocacy groups to provide information to patients and physicians. Additionally, the NML is developing new laboratory testing methods for hepatitis D that they aim to eventually share broadly to help increase detection.

Stopping the spread

Over the years, specialists and infectious disease doctors have started to increase screening of patients that are positive with hepatitis B for hepatitis D as well as screening high-risk individuals, including those immigrating to Canada from countries where hepatitis is endemic. Those most at risk are also at a higher risk for other sexually transmitted and blood-borne infections (STBBI). Many individuals with hepatitis D also have HIV or hepatitis C, meaning that doctors can screen patients for other STBBI if they know the patient already has one of these infections so they can provide the necessary care. To prevent infections, experts are now recommending universal infant vaccination for hepatitis B.

STBBI are preventable, treatable and in many cases curable. However, these infections, including viral hepatitis, remain a significant public health concern in Canada. The Government of Canada is committed to reducing the burden of STBBI in Canada. PHAC will continue its work to reduce the incidence of STBBI in Canada; improve access to testing (particularly for those experiencing difficulties accessing diagnostic services), treatment, and ongoing care and support; and reduce stigma and discrimination that create vulnerabilities to STBBI.