在慢性乙型肝炎（CHB），丁型肝炎病毒（HDV）重复感染可导致急性肝功能衰竭。HDV重复感染的发生率未知，但经常在来自HDV流行国家的移民中发现。在这份报告中,我们描述了长期的临床和病毒学结果在乙型肝炎病毒（HBV）感染载体之前和之后的HDV重叠感染，从他们的配偶获得HBV/HDV共感染。一名38岁的蒙古男性CHB在抗HBV治疗后发展为HDV重叠感染后的急性肝衰竭。虽然他康复了,避免了肝移植的需要,HDV感染的血清学和分子标志物在随后的16个月随访期间持续存在，提示CHB/HDV共感染的发展。他的HDV的来源是他结婚10年的妻子，一名34岁的蒙古女性，已知患有非活动性CHB/HDV共感染，但未接受抗HBV治疗。从夫妇的完整HDV基因组的系统发育分析显示>99％的相似性，传播后纵向序列揭示了配偶双方的HDV基因组序列之间的特定核苷酸替换。这项研究强调了由于CHB患者长期同居或性传播导致的HDV重复感染的持续风险。在结婚近十年后发生传播的事实可能是由于宿主免疫或环境因素为传播创造了更有利的条件。
In chronic hepatitis B (CHB), hepatitis D virus (HDV) superinfection can lead to acute liver failure. The incidence of HDV superinfection is unknown, but is often detected in immigrants from HDV endemic countries. In this report, we characterize long-term clinical and virological outcomes in a hepatitis B virus (HBV) infected carrier before and after HDV superinfection, acquired from their spouse having HBV/HDV co-infection. A 38 year-old Mongolian male with CHB on anti-HBV therapy developed acute liver failure following HDV superinfection. Although he recovered, avoiding the need for liver transplant, HDV serological and molecular markers of infection persisted for the subsequent 16-month follow-up period, suggesting the development of CHB/HDV co-infection. The source of his HDV was from his wife of 10 years, a 34-year old Mongolian female known to have inactive CHB/HDV co-infection but who was not on anti-HBV therapy. Phylogenetic analysis of the complete HDV genome from the couple showed >99% similarity, with post-transmission longitudinal sequence revealing specific nucleotide substitutions between both spouse\'s HDV genome sequences. This study highlights the ongoing risk of HDV superinfection due to long-term co-habitation or sexual transmission in CHB patients. The fact that transmission occurred after almost a decade of marriage may be due to host immune or environmental factors that created a more favorable condition for transmission.
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