Charles Béguelin1, Darius Moradpour2, Roland Sahli3, Franziska Suter-Riniker4, Alexander Lüthi4, Matthias Cavassini5, Huldrych F Günthard6, Manuel Battegay7, Enos Bernasconi8, Patrick Schmid9, Alexandra Calmy10, Dominique L Braun6, Hansjakob Furrer1, Andri Rauch1, Gilles Wandeler11. 1. Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland. 2. Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland. 3. Institute of Microbiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland. 4. Institute for Infectious Diseases, Faculty of Medicine, University of Bern, Switzerland. 5. Division of Infectious Diseases, University Hospital Lausanne, University of Lausanne, Switzerland. 6. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland; Institute of Medical Virology, University of Zurich, Switzerland. 7. Division of Infectious Diseases & Hospital Hygiene, University Hospital Basel, Switzerland. 8. Division of Infectious Diseases, Regional Hospital Lugano, Switzerland. 9. Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, Switzerland. 10. Division of Infectious Diseases, University Hospital Geneva, University of Geneva, Switzerland. 11. Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Switzerland. Electronic address: gilles.wandeler@ispm.unibe.ch.
Abstract
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.
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-infectedpatients 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-infectedpatients 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-coinfectedpatients 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-coinfectedpatients 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.
Authors: Parag Mahale; Peter Aka; Xiaohua Chen; Ruth M Pfeiffer; Ping Liu; Sarah Groover; Maimuna Mendy; Ramou Njie; James J Goedert; Gregory D Kirk; Jeffrey S Glenn; Thomas R O'Brien Journal: J Viral Hepat Date: 2019-02-14 Impact factor: 3.728
Authors: Ângelo Zambam de Mattos; Jose D Debes; Andre Boonstra; Ju-Dong Yang; Domingo C Balderramo; Giovana D P Sartori; Angelo Alves de Mattos Journal: World J Gastroenterol Date: 2021-06-28 Impact factor: 5.742