Jan-Hendrik Bockmann1,2, Marcel Grube3, Vanessa Hamed3, Johann von Felden3, Johanna Landahl3, Malte Wehmeyer3, Katja Giersch3, Michaela T Hall4,5, John M Murray4,5, Maura Dandri3,6, Stefan Lüth3,7, Ansgar W Lohse3,6, Marc Lütgehetmann3,8, Julian Schulze Zur Wiesch3,6. 1. 1st Department of Internal Medicine, University Medical Hospital Hamburg-Eppendorf, Martinistr 52, 20246, Hamburg, Germany. j.bockmann@uke.de. 2. German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel site, Hamburg, Germany. j.bockmann@uke.de. 3. 1st Department of Internal Medicine, University Medical Hospital Hamburg-Eppendorf, Martinistr 52, 20246, Hamburg, Germany. 4. School of Mathematics and Statistics, UNSW Sydney, Sydney, Australia. 5. Cancer Research Division, Cancer Council NSW, Sydney, Australia. 6. German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel site, Hamburg, Germany. 7. Center of Internal Medicine II, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany. 8. Institute of Microbiology, Virology and Hygiene, University Medical Hospital Hamburg-Eppendorf, Hamburg, Germany.
Abstract
BACKGROUND: Chronic hepatitis delta virus (HDV) infection causes severe liver disease which often leads to cirrhosis and hepatocellular carcinoma (HCC). Aim of this study was to establish the disease severity and prognostic factors for disease outcome by analysing frequencies of clinical events and their correlation with baseline virological and biochemical parameters as well as interferon and nucleos(t)ide analogue treatment choice. METHODS: We studied a single-centre cohort of 49 anti-HDAg-positive patients with HBsAg persistence for at least 6 months. Virological and biochemical parameters, interferon and nucleos(t)ide analogue treatment choice as well as clinical events during follow-up were analysed by retrospective chart review (mean follow-up time 3 years, range 0.25-7.67 years). RESULTS: Severe clinical events occurred in 11/49 hepatitis D patients, including HCC (8/49), death (8/49) or liver transplantation (2/49). HCCs only occurred secondary to liver cirrhosis and their event rates in this cohort of hepatitis D patients did not differ from a matched HBV mono-infected cohort with comparable frequency of liver cirrhosis. A stepwise multivariate logistic regression revealed low platelet count (p = 0. 0290) and older age (p = 0.0337) correlating most strongly with overall clinical events, while serum HDV RNA positivity at baseline did not correlate with any clinical outcome. Interferon-free but not nucleos(t)ide analogue-free patient care correlated with the occurrence of HCC at logistic regression, although only 3/18 interferon-treated patients demonstrated repeatedly negative HDV PCR results post therapy. CONCLUSIONS: Our data indicate that progressive liver disease at baseline plays a major role as predictive factor for overall clinical outcome of hepatitis D patients. In particular, HCC risk may not be underestimated in hepatitis D virus RNA negative hepatitis D patients with advanced liver fibrosis.
BACKGROUND:Chronic hepatitis delta virus (HDV) infection causes severe liver disease which often leads to cirrhosis and hepatocellular carcinoma (HCC). Aim of this study was to establish the disease severity and prognostic factors for disease outcome by analysing frequencies of clinical events and their correlation with baseline virological and biochemical parameters as well as interferon and nucleos(t)ide analogue treatment choice. METHODS: We studied a single-centre cohort of 49 anti-HDAg-positive patients with HBsAg persistence for at least 6 months. Virological and biochemical parameters, interferon and nucleos(t)ide analogue treatment choice as well as clinical events during follow-up were analysed by retrospective chart review (mean follow-up time 3 years, range 0.25-7.67 years). RESULTS: Severe clinical events occurred in 11/49 hepatitis Dpatients, including HCC (8/49), death (8/49) or liver transplantation (2/49). HCCs only occurred secondary to liver cirrhosis and their event rates in this cohort of hepatitis Dpatients did not differ from a matched HBV mono-infected cohort with comparable frequency of liver cirrhosis. A stepwise multivariate logistic regression revealed low platelet count (p = 0. 0290) and older age (p = 0.0337) correlating most strongly with overall clinical events, while serum HDV RNA positivity at baseline did not correlate with any clinical outcome. Interferon-free but not nucleos(t)ide analogue-free patient care correlated with the occurrence of HCC at logistic regression, although only 3/18 interferon-treated patients demonstrated repeatedly negative HDV PCR results post therapy. CONCLUSIONS: Our data indicate that progressive liver disease at baseline plays a major role as predictive factor for overall clinical outcome of hepatitis Dpatients. In particular, HCC risk may not be underestimated in hepatitis D virus RNA negative hepatitis Dpatients with advanced liver fibrosis.
Authors: Michel Bazinet; Victor Pântea; Valentin Cebotarescu; Lilia Cojuhari; Pavlina Jimbei; Mark Anderson; Jeff Gersch; Vera Holzmayer; Carina Elsner; Adalbert Krawczyk; Mary C Kuhns; Gavin Cloherty; Ulf Dittmer; Andrew Vaillant Journal: Hepatol Commun Date: 2020-11-13
Authors: Daniel Castaneda; Adalberto Jose Gonzalez; Mohammad Alomari; Kanwarpreet Tandon; Xaralambos Bobby Zervos Journal: World J Gastroenterol Date: 2021-04-28 Impact factor: 5.742