Fiocruz and partner institutions develop molecular test for hepatitis Delta

In collaboration with Fundação Hospital Estadual do Acre (Fundhacre), Centro de Infectologia Charles Mérieux and the Federal University of Acre (Ufac), researchers from Fiocruz Rondônia have described a molecular method for quantifying the viral load of individuals with hepatitis Delta (HDV), a disease that is endemic in regions with high prevalence of hepatitis B (HBV). Despite its importance in the public health context, the molecular diagnosis of the hepatitis Delta virus is not included in the routine of reference laboratories in the country, which makes it difficult to know the actual prevalence and to direct chronic carriers to the most appropriate treatment. The study had 16 researchers involved and was published in Nature's Scientific Reports Magazine.

Researchers described a molecular method for quantifying the viral load of individuals with Delta hepatitis (photo: Fiocruz Rondônia)

The partnership between these institutions began in 2022 and will soon be made official with the signing of a Cooperation Agreement, which will allow expanding actions for the assessing and characterizing other diseases of medical importance in the Amazon, in addition to viral hepatitis. Currently, diagnosis of hepatitis Delta in the Unified Health System (SUS) is carried out through a serological test that only allows for detecting antibodies against the virus, evidence that the person had contact with the virus.

“With this new molecular method that we are now proposing, it is possible to detect and quantify the viral load in the patient's sample, which allows for better monitoring the disease, in addition to providing the medical team with more accurate information regarding the behavior of the virus in the organism and evolution of the clinical condition”, clarifies the researcher Jackson Alves da Silva Queiroz, one of the authors of the study.

The result of this work reflects the efforts of a solid network of researchers, as defended by Daniel da Matta, General Director of Centro de Infectologia Charles Mérieux and Laboratório Rodolpho Mérieux (Fundhacre). “We are talking about a great advance for medicine, considering that combating and treating hepatitis must be a commitment for the whole society, especially when we think about the well-being of the most vulnerable populations in our region, who have limited access to health services”, he concluded.

Virologist Deusilene Vieira, coordinator of the research, believes that “this work favors the understanding of the endemicity and severity of the disease in the North region of the country, as it contributes to the understanding of the behavior of the Delta virus, further being possible to verify whether there is a significant relationship between the amount of virus in infected individuals with the progression of conditions considered severe”.

The molecular test for quantifying the viral load of hepatitis Delta was developed for research purposes and may, in the future, be incorporated into the routine of the Central Public Health Laboratories (Lacens). It was funded by resources from the Inova Fiocruz Program (Edital Inovação na Amazônia [Notice for Innovation in the Amazon]), Fundação Rondônia de Amparo à Pesquisa (Fapero) and the National Institute of Epidemiology in the Western Amazon (INCT/EpiAmO), with support from Fiocruz's Coordination of Health Surveillance and Reference Laboratories.

The molecular method is in the application and monitoring stage for the patients who are part of the study, “which means that all the development part has already been carried out and, today, we are in the monitoring stage of the patients to identify and describe the possible relations between the current stage of the disease, the concentration of virus in the organism and the response to the treatment of these chronic patients”, explained the study coordinator.

The methodology is being applied in Acre and Rondônia, where chronic patients are monitored through the Specialized Care Service (SAE-Fundhacre) and the Viral Hepatitis Outpatient Clinic at the Center for Tropical Medicine Research (Cepem), in Porto Velho-RO. It is expected that this diagnosis expands to a larger number of users, considering that we are talking about an endemic region for hepatitis Delta, and that these two states have approximately 2 thousand chronic carriers of the HDV virus, “hence the importance of a molecular diagnosis that measures the amount of circulating virus for better monitoring and management of patients”, emphasizes Deusilene Vieira.

Hepatitis B and Delta virus infection can contribute to the development of more severe advanced liver disease. In addition to this methodology, Fiocruz Rondônia's Laboratory of Molecular Virology develops studies aimed at the simultaneous detection of the B and Delta viruses in these patients, focusing on approaches in the sequencing of these viruses for the characterization of possible genotypes and mutations that may influence the response to treatment and disease evolution.

Viral hepatitis is an infectious disease that affects the liver. Currently, there are five different viruses recognized as etiological agents of human viral hepatitis: hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C (HCV), hepatitis D or Delta (HDV) and hepatitis E virus (HEV).