Prevalence and Demographic and Clinical Characteristics of Hiv, Hepatitis C, Hepatitis E, and Hepatitis Delta Co-Infections in Individuals With Chronic Hepatitis B in the Brazilian Amazon

Coinfection with HIV and other viral hepatitides such as hepatitis C (HCV), delta (HDV), or hepatitis E (HEV) can accelerate HBV-related liver disease progression. This study aimed to evaluate the prevalence and clinical characteristics of individuals infected with HDV, HCV, HEV, and HIV in a large cohort of HBV-infected individuals in the Brazilian Amazon. Descriptive prospective study of HBV-infected individuals (HBsAg+) followed at two Viral Hepatitis Reference Units in Amazonas state, Brazil, from October 2022 to February 2024. Serological markers for HBV, HDV, HIV, HEV, and HCV were evaluated. Commercial kits (Architect i1000™, Abbott Diagnostics, Brazil, and DiaSorin®, Italy) were used to detect HBsAg, anti-HBc, anti-HBs, HBeAg, anti-HCV, anti-HIV, and anti-HDV. HBV DNA and HDV and HEV RNA were identified using commercial kits (Abbott RealTime HBV Viral Load Assay; Altona Diagnostic RealStar® HDV RT-PCR kit; and HEV RNA kit). Among 356 individuals included, 75.6% (n = 269) were HBV monoinfected, while 24.4% (n = 87) were also coinfected with HDV. Among HDV coinfected individuals, 43 (49.4%) were reactive for HDV RNA. Among all included patients, six were coinfected with HIV (1.7%), one (0.2%) was anti-HCV reactive, and 17 (4.8%) were anti-HEV IgG reactive. Among these, none were viremic for HEV or HCV. Overall mean age was 45.1 (±11.5) years; 183 (51.4%) were female; 57 (16.1%) were from rural areas; 34 (9.6%) were Indigenous; 11 (3.2%) were HBeAg reactive; and 9 (2.5%) had HBV DNA > 2,000 IU/mL. Among all included, 65 (29.3%) had signs of chronic liver disease; only 36 (10.7%) reported being on treatment (or having received prior treatment for hepatitis B at some point in their lives); and 28 (9.4%) reported previously abandoning clinical follow-up. The data confirm low prevalence of hepatitis C and E and a high prevalence of anti-HDV–positive/HDV RNA–positive individuals among HBV-infected patients in the Brazilian Amazon. The findings also point to a large number of individuals with signs of chronic liver disease without access to medications or appropriate clinical follow-up in this region.