COURSE OF CHRONIC HEPATITIS D IN THE INDIGENOUS POPULATION OF THE SAKHA REPUBLIC (YAKUTIA)

The relevance of studying viral hepatitis D is associated with the increasing prevalence of the disease worldwide and an aggressive clinical course compared to other parenteral hepatitis. The Sakha Republic (Yakutia) is a territory of the Russian Federation with a high level of prevalence of hepatitis D virus among the indigenous population. While effective antiviral therapy does not cover all patients in need, chronic HDV-infection leads to the rapid formation of disabling forms of liver disease. The aim of the work was to study the clinical and laboratory features of the course of HDV-infection among the indigenous population of the Sakha Republic (Yakutia) for further use of data in the development of a prognostic model to identify the risk of severe course such as HD-cirrhosis of the liver. We examined 157 patients at different stages of the disease: 71 men and 86 women, aged between 22 and 77 years, with the average age at 48 ± 10.5 years. It was found that 30.6 % of chronic hepatitis proceeds without severe liver fibrosis; 56.1 % of patients have cirrhosis; and 13.3 % have hepatocarcinoma. Liver cirrhosis develops on average 6.8 years after detection of anti-HDV. Epidemiologically significant risk factors for severe course are a history of acute hepatitis B (p=0.038) and intrafamilial contact (p=0.02). The study of the clinical and laboratory picture showed an increase in the severity of the patients’ condition with the formation of cirrhosis and liver cancer. Mixed replication of HBV/HDV was significantly more often (p<0.001) observed in patients with cirrhosis and HCC. The overall mortality rate among patients was 17.8 % and the main cause of death was progressive liver failure.

Conclusion: The territory of the Sakha Republic (Yakutia) is unfavorable in terms of the prevalence of chronic forms of HDV infection. The analysis confirmed a high risk of developing severe fibrosis among the indigenous population in 69 %, which requires strengthening measures for the early diagnosis of complications, as well as increasing the coverage of antiviral treatment for patients in the region.

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