Hepatitis B, C, and Delta—Updates in Screening and Infection Prevention Opportunities for Eradication

Opinion statement

Hepatitis B virus (HBV) is one of the most frequent pathogen worldwide and actively infects around 300 million people in the world. There is an effective recombinant vaccine available from almost 40 years. It is able to elicit protective antibodies levels in more than 95% of the vaccinated population. Nevertheless, HBV causes a chronic disease that in most cases may not be diagnosed for many years due to the absence of clear symptoms during the acute phase as well in the chronic phase before the establishment of severe clinical pictures as liver cirrhosis and hepatocellular carcinoma. To envisage the eradication of HBV, it will be necessary to warrant that (1) the vaccine against this virus was utilized in the whole population, preferentially adding it in national vaccine schedule as vaccination that should be started just after birth and to warrant (2) every infected patient access to effective treatment using pegylated α-interferon or nucleos(t)ide analogs. Hepatitis C virus (HCV) infects 100 to 200 million people around the world according to different statistics. There is not any effective vaccine to avoid this infection, but there are several new drugs called Direct Acting Anti-viral Agents (DAAs) that reach sustained response rate near 100% even with the presence of liver cirrhosis or HIV co-infection. This approach changed hepatitis C epidemiological picture from a widespread disease with large difficulties in succeeding in the treatment to a curable disease in most cases. Although these drugs will not lead to the eradication of hepatitis C, they will significantly decrease the burden of this disease, avoiding the evolution for severe clinical pictures, such as liver cirrhosis, liver failure, and hepatocellular carcinoma. The costs of these drugs shall significantly reduce to warrant these positive effects in the poor populations of underdeveloped countries, which comprehend an important portion of the infected population nowadays. Nevertheless, limited access to DAA treatment, delayed HCV detection, and reinfection after a successful treatment reinforces the need to develop a vaccine for global control of infection.

Hepatitis delta virus (HDV) is a subviral agent infecting only those who have already been infected with HBV (superinfection) or those who are co-infected with both agents. HDV is present in many different world regions, in some of them in higher frequency, such as in Northern South America, sub-Saharan and Mediterranean Africa, Middle East, and many countries in Central Asia. The presence of this virus is increasing around the world due to the recent immigrations. The measures to control HBV also avoid the spread of this infection, but it is necessary to establish more effective ways to treat those individuals already infected by this agent.

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