Epidemiology, Genotype Distribution, Prognosis, Control, and Management of Viral Hepatitis B, C, D, and Hepatocellular Carcinoma in Mongolia

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Abstract

Mongolia is located between Russia and China. The total population of Mongolia as of December 2017 is estimated to be 3.2 million people. According to our previous study results, the prevalence of HBV was 11.8%, and anti-HDV was detected in 4.8% among the HBsAg-positive subjects. Interestingly, most HCV infection is caused by genotype 1b. Among all HBV DNA-positive samples, 98.5% were classified into genotype D, and regarding HDV genotypes, all HDV RNA-positive samples, 100%, were classified into genotype I.

The second study is the baseline survey of a Nationwide Cancer Cohort Study. Prevalence of HBsAg was 10.6%. Additionally, HCV infection was observed in 9.9%, and 0.8% were coinfected with HBV and HCV among the general population aged from 10 to 64 years.

The third study investigated the population-based prevalence of hepatitis B and C virus in apparently healthy population of Ulaanbaatar city, Mongolia. The anti-HCV prevalence was 9.0%. In addition, the prevalence of HBV was 8.0%.

The fourth study is on the prevalence of HCV and coinfections among nurses in a tertiary hospital in Mongolia. The prevalence of HCV was 18.9%. Additionally, HBV infection was observed in 23.1%, and 1.2% were coinfected with HCV and HBV.

Mongolia has the highest HCC incidence in the world (78.1/100,000, 3.5* higher than China).

As a result, the Mongolia government has launched The National Viral Hepatitis Program, which is a comprehensive program that involves all aspects from prevention to care and disease control to meet a reduction goal for morbidity and mortality due to HBV, HCV, and HDV. Consequently, access to antiviral therapies is now improving in Mongolia.

How to cite this article: Baatarkhuu O, Gerelchimeg T, Munkh-Orshikh D, Batsukh B, Sarangua G, Amarsanaa J. Epidemiology, Genotype Distribution, Prognosis, Control, and Management of Viral Hepatitis B, C, D, and Hepatocellular Carcinoma in Mongolia. Euroasian J Hepato-Gastroenterol 2018;8(1):57-62.

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Treatment options for hepatitis delta virus infection.

Heiner Wedemeyer, Benjamin Heidrich, M P Manns (2013)

The hepatitis D virus (HDV), the smallest virus known to infect man, causes the most severe form of chronic viral hepatitis, hepatitis delta. It is estimated that about 15 to 20 million people are suffering from chronic HDV infection. HDV is a defective satellite virus depending on the hepatitis B surface antigen (HBsAg) for transmission. Chronic hepatitis delta is associated with a rapid progression of liver fibrosis and a high prevalence of liver cirrhosis, even in younger patients. Immunization against hepatitis B virus (HBV) protects from HDV infection, but there is no specific vaccine against HDV available for HBsAg-positive individuals. Treatment options for hepatitis delta patients are limited. So far, only interferon-alpha has shown an antiviral efficacy against HDV. Recent trials showed sustained virological response rates concerning HDV in 25 %-30 % of patients treated with pegylated interferons. HDV is dominant over HBV in the majority of cases, but HBV DNA-positive subjects should be treated with HBV polymerase inhibitors. Combination therapy of pegylated interferon-alpha and adefovir showed a more pronounced HBsAg decline, but the exact role of combination therapies in hepatitis delta requires further investigation. Alternative future treatment strategies may include prenylation inhibitors and HBV entry inhibitors, which are in early clinical development.

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High frequency of hepatocellular carcinoma in Mongolia; association with mono-, or co-infection with hepatitis C, B, and delta viruses.

Ruvjir Sanduijav, Fuat Kurbanov, Abeer Elkady … (2006)

To investigate the association between viral infection pattern and hepatocellular carcinoma (HCC), 292 chronic hepatitis patients, including 108 with developed HCC were screened using serological and molecular genetics methods. Viral etiology was established in 267 (91.4%), anti-HCV detected in 198 (67.8%), and HBsAg in 124 (42.5%) including 93 (74.4%) cases with HDV co-infection. HCV mono-infection predominated in both, "non-HCC" and "HCC" groups (54% and 39%, respectively) with higher frequency in the first group (P = 0.011), whereas HBV in co-infection with HDV was more frequent in HCC group (14% vs 25%, P = 0.017). Patients with HCV mono-infection were older than those with co-infection (P<0.02), had higher frequency of HCV-viraemia (82% vs 7%, P < 0.0001), and yet had significantly lower prevalence of HCC (29.6% vs. 49.1%, P = 0.003). Alpha-fetoprotein (AFP) and protein induced by vitamin K antagonist-II (PIVKA-II) were specifically elevated in 71% of HCC patients. In conclusion, although HCV monoinfection pattern predominates in Mongolia, co-infection with HBV and HDV had stronger association with HCC development at younger age. Liver tumor markers; AFP and PIVKA-II are useful tools for complex HCC-screening and clinical follow-up for chronic hepatitis patients in Mongolia. (c) 2006 Wiley-Liss, Inc.

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Is Open Access

Viral Hepatitis and Liver Diseases in Mongolia

Oidov Baatarkhuu, G Uugantsetseg, D Munkh-Orshikh … (2017)

Mongolia is known for its high endemicity for viral hepatitis. Previous studies report that the seroprevalence of hepatitis B virus (HBV) is 11.8% (178/1,512) among the unvaccinated population in 13 provinces and Ulaanbaatar city. The serosurvey of adults (>20 years of age) conducted during 2013 among persons in four provinces and in Ulaanbaatar showed that the overall prevalence of hepatitis B surface antigen (HBsAg) positivity was 10.6%. The overall prevalence of anti-hepatitis C virus (HCV) and HCV ribonucleic acid among 1,512 apparently healthy subjects was 15.6% (236/1,512) and 11.0% (167/1,512) respectively. In a previous study, we reported on the prevalence of HBV, HDV, and HCV infections in 110 consecutive patients presenting with acute hepatitis at eight city hospitals in Ulaanbaatar. In that study, 16.4, 32.7, 6.4, 1.8, and 27.3% of the patients were diagnosed as having acute hepatitis due to hepatitis A, B, C, HBV/HDV coinfection, and superinfection respectively. In the current study (2012-2014), results show that acute hepatitis A, B, C, and D was diagnosed in 47.9, 40.7, 5.3, and 9% respectively. Chronic HBV and HCV infections, which are associated with cancer and cirrhosis respectively, are responsible for 95% of liver cancers in Mongolia. The most common etiology for hepatocellular carcinoma was HCV infection (n = 89, 45.6%), followed by HBV infection (n = 67, 34.4%). How to cite this article: Baatarkhuu O, Uugantsetseg G, Munkh-Orshikh D, Naranzul N, Badamjav S, Tserendagva D, Amarsanaa J, Young KD. Viral Hepatitis and Liver Diseases in Mongolia. Euroasian J Hepato-Gastroenterol 2017;7(1):68-72.

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Author and article information

Journal

Journal ID (nlm-ta): Euroasian J Hepatogastroenterol

Journal ID (iso-abbrev): Euroasian J Hepatogastroenterol

Journal ID (publisher-id): EJOHG

Title: Euroasian Journal of Hepato-Gastroenterology

Publisher: Jaypee Brothers Medical Publishers

ISSN (Print): 2231-5047

ISSN (Electronic): 2231-5128

Publication date (Print): Jan-Jun 2018

Publication date (Electronic): 01 May 2018

Volume: 8

Issue: 1

Pages: 57-62

Affiliations

[1 ]Department of Infectious Diseases, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia; Mongolian Association for the Study of Liver Diseases, Ulaanbaatar, Mongolia

[2 ]Department of Infectious Diseases, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia; National Center for Communicable Diseases, Ulaanbaatar, Mongolia

[3 ]Mongolian Association for the Study of Liver Diseases, Ulaanbaatar, Mongolia; Happy Veritas Clinic and Diagnostic Center, Ulaanbaatar, Mongolia

[4 ]Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea

Author notes

Address reprint requests to: Oidov Baatarkhuu, Department of Infectious Diseases, Mongolian National University of Medical Sciences Ulaanbaatar, Mongolia; Mongolian Association for the Study of Liver Diseases, Ulaanbaatar, Mongolia; Department of Infectious Diseases Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia; National Center for Communicable Diseases, Ulaanbaatar Mongolia, e-mail: baatarkhuu@mnums.edu.mn

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DOI: 10.5005/jp-journals-10018-1260

PMC ID: 6024043

PubMed ID: 29963464

SO-VID: 6755ad47-5b1c-49c6-8943-0f787a5d2bf7

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This work is licensed under a Creative Commons Attribution 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by/3.0/

Epidemiology, Genotype Distribution, Prognosis, Control, and Management of Viral Hepatitis B, C, D, and Hepatocellular Carcinoma in Mongolia

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Most cited references 19

Treatment options for hepatitis delta virus infection.

High frequency of hepatocellular carcinoma in Mongolia; association with mono-, or co-infection with hepatitis C, B, and delta viruses.

Viral Hepatitis and Liver Diseases in Mongolia

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