Prevalence and biomarker profiles of HBV/HDV coinfection and occult HBV infection among patients attending Bimbilla Hospital, Northern Ghana.

BACKGROUND & AIMS: Coinfection of hepatitis B virus (HBV) with hepatitis D virus (HDV) may exacerbate liver injury, particularly in resource-limited settings. In Ghana, data on HDV and OBI prevalence, as well as their hepatic impact, remain sparse. This study aimed to determine the prevalence of HDV and OBI using real-time PCR and evaluate their effects on liver-related biomarkers in patients at Bimbila Hospital, Northern Ghana.

METHODS

We conducted a cross-sectional study at Bimbilla Hospital, Northern Ghana, between May and December 2024, recruiting 60 consented patients with Hepatitis B Surface Antigen positive and 60 patients with HBsAg-negative status. HBV serology (HBsAg, HBeAg, anti-HBs, total anti-HBc) was performed using a 5-in-1 panel. HBV DNA and HDV RNA were detected by real-time PCR. HDV prevalence was determined among HBsAg-positive participants by real-time PCR detection of HDV RNA, while OBI prevalence was determined among HBsAg-negative participants by the presence of detectable HBV DNA using real-time PCR following serological screening. Liver biochemical, haematological, and inflammatory markers were measured, and fibrotic indices (APRI, FIB-4, PLR, GLR) were computed. Data were analysed using SPSS 26 and GraphPad Prism version 8.

RESULTS

HDV RNA was detected in 11/60 HBsAg-positive participants (18.3%, 95% CI 10.66-29.9). OBI occurred in 5/60 HBsAg-negative participants (8.3%, 95% CI 3.6-18.1). Compared to HBV-monoinfected individuals, HBV/HDV-coinfected patients had higher Gamma-Glutamyltransferase (GGT;45.0 vs. 37.0 IU/L, p < 0.05), lower Albumin/Globulin Ratio (A/G;1.21 vs. 1.34, p < 0.05), elevated Granulocyte-to-Lymphocyte Ratio (GLR; 2.60 vs. 1.87, p < 0.05), and higher Platelet-to-Lymphocyte Ratio (PLR; 143.00 vs. 89.87, p < 0.05). HBV/HDV coinfected patients also showed elevated Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), total bilirubin (TBIL), IBL, AST/ALT ratio (de Ritis), and Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) scores compared to those with OBI.

CONCLUSION

In Northern Ghana, HDV coinfection may be associated with significant alterations in GGT, AST, ALT, bilirubin levels, de-Ritis ratio, APRI, PLR, and GLR, with concurrent reduction in the A/G ratio, suggesting significant hepatic and inflammatory disturbances, whereas OBI may show no comparable biomarker alterations.

CLINICAL TRIAL: Not applicable.