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Viruses
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Viral Hepatitis in Latin America and the Caribbean
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Viral Hepatitis in Latin America and the Caribbean

A special issue of Viruses (ISSN 1999-4915). This special issue belongs to the section "Human Virology and Viral Diseases".

Deadline for manuscript submissions: closed (30 December 2024) | Viewed by 16051

Special Issue Editors

Dr. Lia L. Lewis-Ximenez

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Guest Editor
Viral Hepatitis Ambulatory, Viral Hepatitis Laboratory, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro, Brazil
Interests: acute viral hepatitis; hepatitis A; hepatitis B; hepatitis C; hepatitis E; immune response; occult hepatitis; viral hepatitis during pregnancy; mother-to-infant transmission; vulnerable high-risk populations; rapid diagnostic tests; hemodialysis; indigenous populations
Special Issues, Collections and Topics in MDPI journals
Dr. Livia Melo Villar

E-Mail Website
Guest Editor
Viral Hepatitis Laboratory, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro, Brazil
Interests: viral hepatitis; innovation in the diagnosis of hepatitis; molecular epidemiology; epidemiology; the biology of viral hepatitis; vulnerable high-risk populations; indigenous populations
Special Issues, Collections and Topics in MDPI journals
Dr. Carlos Alberto Espul

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Guest Editor
Laboratorio de Virología, Hospital Central, Mendoza, Argentina
Interests: gastroenteritis viruses; hepatitis viruses
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Flor Helene Pujol

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Guest Editor
Laboratorio de Virología Molecular, Centro de Microbiología y Biología Celular (CMBC), Instituto Venezolano de Investigaciones Científicas (IVIC), Caracas 1020A, Venezuela
Interests: hepatitis viruses; HIV; SARS-CoV-2; influenza; emerging viruses; viral genomics
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Sonia Roman

E-Mail Website
Guest Editor
Laboratory of Molecular Biology in Medicine, Health Sciences Center, University of Guadalajara, Guadalajara, Mexico
Interests: viral hepatitis; cirrhosis; molecular epidemiology; diagnosis; immunology

Special Issue Information

Dear Colleagues,

Viral hepatitis is a major global concern, as it contributes to the toll of deaths from infectious diseases and cancer worldwide. The five main types of hepatitis (A, B, C, D, and E) vary in terms of their transmission routes, geographic distributions, and clinical outcomes. In the context of Latin America and the Caribbean, these infections have great public health relevance but scarce and limited data. Even with the significant reduction in the number of cases among younger age groups over the decades, especially in light of vaccine availability and improved access to sanitation and drinking water services, hepatitis A (HAV) still exhibits high or intermediate endemicity in certain countries of this region, leading to epidemic outbreaks, especially among susceptible adults (with a higher mortality rate) and vulnerable populations. In the case of hepatitis B (HBV) and C (HCV), it is estimated that approximately 4.7 million individuals are chronically infected, leading to millions of deaths related to liver cancer and cirrhosis. As for hepatitis D (or Delta) (HDV), most Latin American studies have focused mainly on the Amazon Basin region. Few studies have explored regions outside this endemic area, meaning that the infection, which has great importance in the context of co-infection with HBV, is neglected. Hepatitis E (HEV), on the other hand, still has a very limited epidemiology in Latin America and the Caribbean, with rates of prevalence ranging from 1% (in Caribbean countries) to 12% (Nicaragua and Chile). It is likely that these numbers represent a significant underestimation of the true global burden of the disease and its incidence in the region. To shed light on and provide new information about viral hepatitis in the context of Latin America and the Caribbean, new studies are required in order to provide data relevant to this highly diverse region.

With this objective in mind, this Special Issue of Viruses will address the following topics: 1) genetic variations in viral hepatitis, which may aid us in understanding the diverse types of response (clinical outcomes, treatments, immunological factors); 2) general epidemiological studies and those focusing on key populations; and 3) new diagnostic procedures that will aid in the elimination of these viruses.

Dr. Lia L. Lewis-Ximenez
Dr. Livia Melo Villar
Dr. Carlos Alberto Espul
Prof. Dr. Flor Helene Pujol
Prof. Dr. Sonia Roman
Guest Editors

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Keywords

  • viral hepatitis
  • Latin America
  • key populations
  • epidemiology
  • molecular epidemiology
  • therapy
  • diagnostics
  • new diagnostic technologies
  • immune response
  • clinical outcome
  • genotype

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Related Special Issue

Published Papers (9 papers)

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Research

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11 pages, 254 KiB  
Article
Effectiveness of Direct Antiviral Agents in People with HCV-Monoinfection Compared to HCV/HIV Coinfection in a Real Life Setting
by Cristina Guadalupe Román López, Salma Triana González, Ana Luz Cano Díaz, Dulce Daniela Flores Lopez, José Antonio Mata Marín and Jesús Enrique Gaytán Martínez
Viruses 2024, 16(11), 1724; https://doi.org/10.3390/v16111724 - 31 Oct 2024
Viewed by 891
Abstract
Direct-acting antivirals (DAA) are effective in patients with hepatitis C virus (HCV) infection, but there is little information about real-world effectiveness in people living with human immunodeficiency virus (PLH). The aim of this study was to determinate the effectiveness of DAA to achieve [...] Read more.
Direct-acting antivirals (DAA) are effective in patients with hepatitis C virus (HCV) infection, but there is little information about real-world effectiveness in people living with human immunodeficiency virus (PLH). The aim of this study was to determinate the effectiveness of DAA to achieve sustained virologic response at week 12 post-treatment (SVR12) in PLH with HCV coinfection and in people with HCV-monoinfection. We conducted a prospective cohort. The full analysis set (FAS) included all subjects enrolled in the study; the modified analysis set (MAS) excluded cases with missing data to evaluate SVR12. A total of 278 people were included, 130 (46.7%) with HCV/HIV-coinfection and 148 (53.2%) with HCV-monoinfection. In the HCV/HIV-coinfection group, 82 (63%) received GLE/PIB for 8 weeks, 45 (34.6%) received SOF/VEL for 12 weeks, and 3 (2.3%) were treated with SOF/VEL + RBV for 12 weeks. In the HCV-monoinfection group, 62 (41.8%) received GLE/PIB for 8 weeks, 28 (18.9%) received SOF/VEL for 12 weeks, and 58 (39.1%) participants were treated with SOF/VEL + RBV for 12 weeks. In the FAS analysis, SVR12 was 81.6% in the HCV/HIV-coinfection group and 86.4% in the HCV-monoinfection group (p = 0.128). In the MAS analysis, both groups achieved 100% of SVR12. In this cohort, the effectiveness of DAA to achieve SVR12 was similar between HCV/HIV-coinfection and HCV-monoinfection cases, regardless of advanced liver disease with no differences between treatment regimens. Full article
(This article belongs to the Special Issue Viral Hepatitis in Latin America and the Caribbean)
12 pages, 2759 KiB  
Article
Genetic Spatio-Temporal Analysis of Hepatitis D Virus Infection in Western Brazilian Amazon
by Tárcio P. Roca, Jackson A. S. Queiroz, Ana M. Passos-Silva, Adrhyan Araújo, Barbara V. Lago, Francisco C. A. Mello, Juan M. V. Salcedo, Deusilene Vieira and Livia M. Villar
Viruses 2024, 16(11), 1690; https://doi.org/10.3390/v16111690 - 29 Oct 2024
Viewed by 763
Abstract
The Brazilian Amazon region is a highly endemic area for hepatitis Delta and has areas that are difficult to access. Understanding the dynamics of HDV transmission in these remote locations is important for elucidating the routes of infection. To investigate this, a molecular [...] Read more.
The Brazilian Amazon region is a highly endemic area for hepatitis Delta and has areas that are difficult to access. Understanding the dynamics of HDV transmission in these remote locations is important for elucidating the routes of infection. To investigate this, a molecular analysis of HDV was conducted to assess the spatio-temporal dynamics of HDV cases. Between 2010 and 2023, 35 patients were recruited from the Viral Hepatitis Outpatient Clinic in Rondônia, Brazil. Conventional PCR was used to amplify the complete HDV genome followed by nucleotide sequencing via the Sanger method. The HDV genotype was determined using maximum likelihood phylogenetic reconstruction. A Skygrid coalescent approach with a Relaxed Random Walk phylogeographic model was used for the spatio-temporal analysis. Most individuals were males (21/35), with a median age of 39 years. HDV-3 was identified in all samples (35/35; 100%). The tMRCA was estimated to be 1824, with a substitution rate of 8.2 × 10−4 substitutions/site/year. The results suggest that HDV likely entered Brazil around 1820, in the state of Amazonas, subsequently spreading to Acre and Rondônia. Notable migration events were observed starting from 2010. This study suggests that HDV-3 has a complex evolutionary history spanning over two centuries, with intricate transmission routes in different locations in Brazil. Full article
(This article belongs to the Special Issue Viral Hepatitis in Latin America and the Caribbean)
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11 pages, 1602 KiB  
Article
Hepatitis A, B, and C in Brazilian Afro-Descendant Communities from Northeast Brazil: A Seroepidemiological Survey
by Barbara V. Lago, Aline B. Cardoso, Giselle P. Nascimento, Edvan Pereira, Rony A. Oliveira, Mônica de Avelar Figueiredo Mafra Magalhães, Juliana C. Miguel, Filipe Anibal Carvalho-Costa, Jacenir Reis dos Santos-Malett, Jurema Corrêa Da Mota, Francisco Inácio Bastos and Livia Melo Villar
Viruses 2024, 16(11), 1652; https://doi.org/10.3390/v16111652 - 23 Oct 2024
Viewed by 1017
Abstract
Background: Viral hepatitis is a disease that is more prevalent among individuals residing in remote regions and in contexts of social vulnerability. The objective of this study was to ascertain the seroprevalence of hepatitis A (HAV), B (HBV), and C (HCV) in vulnerable [...] Read more.
Background: Viral hepatitis is a disease that is more prevalent among individuals residing in remote regions and in contexts of social vulnerability. The objective of this study was to ascertain the seroprevalence of hepatitis A (HAV), B (HBV), and C (HCV) in vulnerable communities in the rural area of São João do Piauí (SJP), northern Brazil. Methods: Immunoenzymatic assays were employed to detect the presence of anti-HAV (total and IgM), HBsAg, anti-HBc, anti-HBs, and anti-HCV serological markers in serum samples. Samples that yielded positive results were subjected to further analysis using real-time polymerase chain reaction (PCR). Results: A total of 492 individuals, ranging in age from 3 to 101 years, were consecutively recruited from eight rural communities. The majority of individuals were female (51.2%), over 30 years of age (57.1%), self-identified as Black/Brown (92.2%), and resided in Afro-Brazilian communities, designated as “quilombos” (68.1%). The seroprevalence of anti-HAV was 69.5% (95% CI: 65.4–73.6%), while that of anti-HBc was 4.7% (95% CI: 2.8–6.6%), and that of anti-HBs was 35.2% (95% CI: 30.1–39.4%), and 0.2% (95% CI:0.0–0.6%) for anti-HCV. Conclusions: The seroprevalence rates observed were higher than the national average, and a significant proportion of individuals in the target age groups were susceptible to HBV, despite the availability of vaccination. These findings highlight potential shortcomings in the management of vaccine-preventable diseases, which could have implications for public health. Full article
(This article belongs to the Special Issue Viral Hepatitis in Latin America and the Caribbean)
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14 pages, 2302 KiB  
Article
Mixed Infections Unravel Novel HCV Inter-Genotypic Recombinant Forms within the Conserved IRES Region
by Natalia Echeverría, Fabiana Gámbaro, Stéphanie Beaucourt, Martín Soñora, Nelia Hernández, Juan Cristina, Gonzalo Moratorio and Pilar Moreno
Viruses 2024, 16(4), 560; https://doi.org/10.3390/v16040560 - 3 Apr 2024
Viewed by 1530
Abstract
Hepatitis C virus (HCV) remains a significant global health challenge, affecting millions of people worldwide, with chronic infection a persistent threat. Despite the advent of direct-acting antivirals (DAAs), challenges in diagnosis and treatment remain, compounded by the lack of an effective vaccine. The [...] Read more.
Hepatitis C virus (HCV) remains a significant global health challenge, affecting millions of people worldwide, with chronic infection a persistent threat. Despite the advent of direct-acting antivirals (DAAs), challenges in diagnosis and treatment remain, compounded by the lack of an effective vaccine. The HCV genome, characterized by high genetic variability, consists of eight distinct genotypes and over ninety subtypes, underscoring the complex dynamics of the virus within infected individuals. This study delves into the intriguing realm of HCV genetic diversity, specifically exploring the phenomenon of mixed infections and the subsequent detection of recombinant forms within the conserved internal ribosome entry site (IRES) region. Previous studies have identified recombination as a rare event in HCV. However, our findings challenge this notion by providing the first evidence of 1a/3a (and vice versa) inter-genotypic recombination within the conserved IRES region. Utilizing advanced sequencing methods, such as deep sequencing and molecular cloning, our study reveals mixed infections involving genotypes 1a and 3a. This comprehensive approach not only confirmed the presence of mixed infections, but also identified the existence of recombinant forms not previously seen in the IRES region. The recombinant sequences, although present as low-frequency variants, open new avenues for understanding HCV evolution and adaptation. Full article
(This article belongs to the Special Issue Viral Hepatitis in Latin America and the Caribbean)
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11 pages, 286 KiB  
Article
Core Promoter and Pre-Core Variants of the Hepatitis B Virus (HBV) Are Frequent in Chronic Hepatitis B HBeAg-Negative Patients Infected by Genotypes A and D
by Tania Reuter, Michele Soares Gomes-Gouvea, Samira Chuffi, Ulisses Horst Duque, Waltesia Perini, Raymundo Soares Azevedo and João Renato Rebello Pinho
Viruses 2023, 15(12), 2339; https://doi.org/10.3390/v15122339 - 29 Nov 2023
Viewed by 1295
Abstract
In Brazil, hepatitis B virus endemicity is low, moderate, or high in some areas, such as Espírito Santo State in the southeast region. In this study, we intend to characterize the basal core promoter (BCP) and pre-core region (PC) variants and their association [...] Read more.
In Brazil, hepatitis B virus endemicity is low, moderate, or high in some areas, such as Espírito Santo State in the southeast region. In this study, we intend to characterize the basal core promoter (BCP) and pre-core region (PC) variants and their association with clinical/epidemiological disease patterns in patients infected with genotypes A and D. The study included 116 chronic hepatitis B patients from Espírito Santo State, Southeast Brazil, infected with genotypes A and D. Basal core promoter (BCP) and pre-core mutations were analyzed in these patients. The frequency of BCP and PC mutations was compared with age, HBeAg status, HBV genotype and subgenotype, HBV-DNA level, clinical classification, and transmission route. HBeAg-negative status was found in 101 (87.1%) patients: 87 (75.0%) were infected with genotype A (A1 = 85; A2 = 2) and 29 (25.0%) were infected with genotype D (D3 = 24; D4 = 3; D2 = 2). BCP + PC variants altogether were more frequent (48.1%) in genotype D than in genotype A strains (6.0%) (p < 0.001). When this evaluation was performed considering the cases that presented only the A1762T and/or G1764A (BCP) mutations, it was observed that the frequency was higher in genotype A (67.5%) compared to genotype D (7.4%) (p < 0.001). On the other hand, considering the samples with mutations only in positions G1896A and/or G1899A (PC), the frequency was higher in genotype D (75.8%) than in genotype A (6.9%) (p < 0.001). Interestingly, HBV DNA was lower than 2000 IU/mL especially when both BCP/PC mutations were present (p < 0.001) or when only PC mutations were detected (p = 0.047), reinforcing their role in viral replication. Full article
(This article belongs to the Special Issue Viral Hepatitis in Latin America and the Caribbean)
10 pages, 741 KiB  
Article
Hepatitis C and Human Pegivirus Coinfection in Patients with Chronic Hepatitis C from the Brazilian Amazon Region: Prevalence, Genotypes and Clinical Data
by Patrícia Ferreira Nunes, Evelen da Cruz Coelho, Joseane Rodrigues da Silva, Camila Carla da Silva Costa, Regiane Miranda Arnund Sampaio, Paula Cristina Rodrigues Frade, Nagib Abdon Ponteira, Samara Silveira da Cruz, Aline Damasceno Seabra, Debora Monteiro Carneiro, Rommel Mario Rodriguez Burbano and Luisa Caricio Martins
Viruses 2023, 15(9), 1892; https://doi.org/10.3390/v15091892 - 7 Sep 2023
Cited by 1 | Viewed by 1824
Abstract
Coinfection of HPgV-1 with hepatitis C virus (HCV) is common due to shared modes of transmission, with a prevalence of HPgV-1 viremia of approximately 20% among individuals with chronic HCV infection. The aim of the present study was to estimate the prevalence of [...] Read more.
Coinfection of HPgV-1 with hepatitis C virus (HCV) is common due to shared modes of transmission, with a prevalence of HPgV-1 viremia of approximately 20% among individuals with chronic HCV infection. The aim of the present study was to estimate the prevalence of HPgV-1 RNA and circulating genotypes in patients with hepatitis C from a health service located in the city of Belém, in the state of Pará, Northern Brazil. A total of 147 samples were included in the study from February to December 2019. Among the participants, 72.1% (106/147) were monoinfected with HCV, with detectable HCV viral RNA, and 27.9% (41/147) were coinfected with HCV/HPgV-1. The most frequently found genotypes were HPgV-1 genotypes 1 and 2 (36.6% and 63.4%), respectively. While for HCV there was a predominance of genotypes 1 and 3 (58.5% and 41.5%). No significant differences were found when comparing any risk, sociodemographic, or clinical factors between groups. Also, there was no statistically significant difference when relating the viral genotypes of both agents. This study indicated that the prevalence of infection by HPgV-1 is high in HCV carriers in Belém, Pará, and probably does not change the clinical course of HCV infection, however, further studies are still needed. Full article
(This article belongs to the Special Issue Viral Hepatitis in Latin America and the Caribbean)
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12 pages, 307 KiB  
Article
Donated Blood Screening for HIV, HCV and HBV by ID-NAT and the Residual Risk of Iatrogenic Transmission in a Tertiary Care Hospital Blood Bank in Puebla, Mexico
by Francisca Sosa-Jurado, Roxana Palencia-Lara, Cinthia Xicoténcatl-Grijalva, Maribel Bernal-Soto, Álvaro Montiel-Jarquin, Yolanda Ibarra-Pichardo, Nora Hilda Rosas-Murrieta, Rosalia Lira, Paulina Cortes-Hernandez and Gerardo Santos-López
Viruses 2023, 15(6), 1331; https://doi.org/10.3390/v15061331 - 6 Jun 2023
Cited by 4 | Viewed by 1983
Abstract
Hepatitis C virus (HCV), human immunodeficiency virus (HIV) and hepatitis B virus (HBV) can be transmitted by blood transfusion. Most transmission occurs during the acute viremic phase (AVP), before antibody development. To reduce transmission risk, individual donor nucleic acid testing (ID-NAT) is used. [...] Read more.
Hepatitis C virus (HCV), human immunodeficiency virus (HIV) and hepatitis B virus (HBV) can be transmitted by blood transfusion. Most transmission occurs during the acute viremic phase (AVP), before antibody development. To reduce transmission risk, individual donor nucleic acid testing (ID-NAT) is used. In Puebla, Mexico, serological tests and ID-NAT have been applied to screen blood donors and detect individuals in AVP. In the present study, 106,125 blood donors’ data in two periods (2012–2015 and 2017–2019) were analyzed. The residual risk (RR) values were calculated considering ID-NAT results. The RR for HIV was 14 in 1 million donations or 1 in 71,428, the RR for HVC was 6.8 in 1 million donations or 1 in 147,058 and, for HBV, it was 156 in 1 million donations, or 1 in 6410. Previously, it was predicted that the transmission RR of these viruses would be reduced in Mexico through better screening with NAT. The use of ID-NAT has, indeed, increased the safety of blood reserves for HIV and HCV. However, more research is needed to determine why the residual risk of HBV did not decrease as much over the study period. ID-NAT is an important complementary tool for blood donor screening that should be implemented. Full article
(This article belongs to the Special Issue Viral Hepatitis in Latin America and the Caribbean)

Review

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25 pages, 3287 KiB  
Review
Hepatitis B Virus Genotype H: Epidemiological, Molecular, and Clinical Characteristics in Mexico
by Arturo Panduro, Sonia Roman, Saul Laguna-Meraz and Alexis Jose-Abrego
Viruses 2023, 15(11), 2186; https://doi.org/10.3390/v15112186 - 30 Oct 2023
Cited by 7 | Viewed by 3089
Abstract
The hepatitis B virus (HBV), comprising of ten genotypes (A-J), has been a silent threat against humanity, constituting a public health problem worldwide. In 2016, the World Health Organization set forth an impressive initiative for the global elimination of viral hepatitis by 2030. [...] Read more.
The hepatitis B virus (HBV), comprising of ten genotypes (A-J), has been a silent threat against humanity, constituting a public health problem worldwide. In 2016, the World Health Organization set forth an impressive initiative for the global elimination of viral hepatitis by 2030. As the target date approaches, many nations, particularly in the Latin American region, face challenges in designing and implementing their respective elimination plan. This review aimed to portray the state of knowledge about the epidemiological, molecular, and clinical characteristics of HBV genotype H (HBV/H), endemic to Mexico. PubMed, Scopus, Web of Science, and Google Scholar were searched to compile scientific literature over 50 years (1970–2022). A total of 91 articles were organized into thematic categories, addressing essential aspects such as epidemiological data, risk factors, HBV genotype distribution, HBV mixed infections, clinical characteristics, and vaccination. The prevalence and its associated 95% confidence interval (95% CI) were estimated using the Metafor package in R programming language (version 4.1.2). We provide insights into the strengths and weaknesses in diagnostics and prevention measures that explain the current epidemiological profile of HBV/H. Training, research, and awareness actions are required to control HBV infections in Mexico. These actions should contribute to creating more specific clinical practice guides according to the region’s characteristics. Mexico’s elimination plan for HBV will require teamwork among the government health administration, researchers, physicians, specialists, and civil society advocates to overcome this task jointly. Full article
(This article belongs to the Special Issue Viral Hepatitis in Latin America and the Caribbean)
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16 pages, 4050 KiB  
Review
Tracing the History of Hepatitis E Virus Infection in Mexico: From the Enigmatic Genotype 2 to the Current Disease Situation
by Oliver Viera-Segura, Arturo Calderón-Flores, Julio A. Batún-Alfaro and Nora A. Fierro
Viruses 2023, 15(9), 1911; https://doi.org/10.3390/v15091911 - 12 Sep 2023
Cited by 4 | Viewed by 2422
Abstract
Hepatitis E virus (HEV) is the major cause of acute viral hepatitis worldwide. This virus is responsible for waterborne outbreaks in low-income countries and zoonosis transmission in industrialized regions. Initially, considered self-limiting, HEV may also lead to chronic disease, and evidence supports that [...] Read more.
Hepatitis E virus (HEV) is the major cause of acute viral hepatitis worldwide. This virus is responsible for waterborne outbreaks in low-income countries and zoonosis transmission in industrialized regions. Initially, considered self-limiting, HEV may also lead to chronic disease, and evidence supports that infection can be considered a systemic disease. In the late 1980s, Mexico became a hot spot in the study of HEV due to one of the first virus outbreaks in Latin America related to enterically transmitted viral non-A, non-B hepatitis. Viral stool particles recovered from Mexican viral hepatitis outbreaks represented the first identification of HEV genotype (Gt) 2 (Gt2) in the world. No new findings of HEV-Gt2 have been reported in the country, whereas this genotype has been found in countries on the African continent. Recent investigations in Mexico have identified other strains (HEV-Gt1 and -Gt3) and a high frequency of anti-HEV antibodies in animal and human populations. Herein, the potential reasons for the disappearance of HEV-Gt2 in Mexico and the advances in the study of HEV in the country are discussed along with challenges in studying this neglected pathogen. These pieces of information are expected to contribute to disease control in the entire Latin American region. Full article
(This article belongs to the Special Issue Viral Hepatitis in Latin America and the Caribbean)
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