Hepatitis delta-associated mortality in HIV/HBV-coinfected patients

Publication

Hepatitis delta-associated mortality in HIV/HBV-coinfected patients

Journal Paper/Review - Oct 14, 2016

Béguelin Charles, Wandeler Gilles, Rauch Andri, Furrer Hansjakob, Braun Dominique L, Calmy Alexandra, Schmid Patrick, Bernasconi Enos, Battegay Manuel, Günthard Huldrych F, Cavassini Matthias, Lüthi Alexander, Suter-Riniker Franziska, Sahli Roland, Moradpour Darius

Citation

Béguelin C, Wandeler G, Rauch A, Furrer H, Braun D, Calmy A, Schmid P, Bernasconi E, Battegay M, Günthard H, Cavassini M, Lüthi A, Suter-Riniker F, Sahli R, Moradpour D. Hepatitis delta-associated mortality in HIV/HBV-coinfected patients. J Hepatol 2016; 66:297-303.

Type

Journal Paper/Review (English)

Journal

J Hepatol 2016; 66

Publication Date

Oct 14, 2016

Issn Electronic

1600-0641

Pages

297-303

Brief description/objective

BACKGROUND & AIMS
Hepatitis delta virus (HDV) infection accelerates the progression of hepatitis B virus (HBV)-related liver disease. We assessed the epidemiological characteristics of HDV infection in the nationwide Swiss HIV Cohort Study and evaluated its impact on clinical outcomes.

METHODS
All HIV-infected patients with a positive hepatitis B surface antigen test were considered and tested for anti-HDV antibodies. HDV amplification and sequencing were performed in anti-HDV-positive patients. Demographic and clinical characteristics at initiation of antiretroviral therapy, as well as causes of death were compared between HDV-positive and HDV-negative individuals using descriptive statistics. Kaplan-Meier and multivariable Cox regression analyses were used to evaluate the association between HDV infection and overall mortality, liver-related mortality as well as incidence of hepatocellular carcinoma (HCC).

RESULTS
Of 818 patients with a positive hepatitis B surface antigen tests, 771 (94%) had a stored serum sample available and were included. The prevalence of HDV infection was 15.4% (119/771, 95% CI: 12.9-18.0) and the proportion of HDV-positive patients with HDV replication 62.9% (73/116). HDV-infected patients were more likely to be persons who inject drugs (60.6% vs. 9.1%) and to have a positive hepatitis C virus (HCV) serology (73.1% vs. 17.8%) compared to HDV-uninfected ones. HDV infection was strongly associated with overall death (adjusted hazard ratio 2.33, 95% CI 1.41-3.84), liver-related death (7.71, 3.13-18.97) and with the occurrence of HCC (9.30, 3.03-28.61). Results were similar when persons who inject drugs or HCV-coinfected patients were excluded from the analyses.

CONCLUSIONS
The prevalence of HDV in hepatitis B surface antigen-positive patients in the Swiss HIV Cohort Study (SHCS) is high and HDV infection is independently associated with mortality and liver-related events, including HCC.

LAY SUMMARY
Hepatitis delta virus (HDV) infection accelerates the progression of hepatitis B virus (HBV)-related liver disease. In a nationwide cohort of HIV-infected individuals in Switzerland, 15% of HBV-coinfected patients had antibodies to HDV infection, of which a majority had active HDV replication. HDV-infected individuals were 2.5 times more likely to die, eight times more likely to die from a liver-related cause and nine times more likely to develop liver cancer compared to HDV-uninfected ones. Our results emphasize the need for prevention programs (including HBV vaccination), the systematic screening of at risk populations as well as close monitoring, and underline the importance of developing new treatments for chronic HDV infection.