Habiba Kamal1,2, Gabriel Westman3, Karolin Falconer1,2, Ann-Sofi Duberg4, Ola Weiland1,2, Susanna Haverinen1, Rune Wejstål5, Tony Carlsson6, Christian Kampmann7, Simon B Larsson8, Per Björkman9, Anders Nystedt10, Kristina Cardell10, Stefan Svensson11, Stephan Stenmark12, Heiner Wedemeyer13, Soo Aleman1,2. 1. Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden. 2. Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden. 3. Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden. 4. Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden. 5. Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden. 6. Department of Infectious Diseases, Danderyd University Hospital, Stockholm, Sweden. 7. Department of Infectious Diseases, Skåne University Hospital Lund, Lund, Sweden. 8. Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 9. Department of Infectious Diseases, Skåne University Hospital Malmö, Malmö, Sweden. 10. Department of Infectious Diseases, Sunderby Hospital, Lulea, Sweden. 11. Department of Infectious Diseases and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. 12. Department of Infectious Diseases, University Hospital of Umeå, Umeå, Sweden. 13. Department of Gastroenterology and Hepatology, University of Essen, Essen, Germany.
Abstract
BACKGROUND AND AIMS: Hepatitis delta virus (HDV) infection is associated with fast progression to liver cirrhosis and liver complications. Previous studies have, however, been mainly from tertiary care centers, with risk for referral bias toward patients with worse outcomes. Furthermore, the impact of HDV viremia per se on liver-related outcomes is not really known outside the human immunodeficiency virus co-infection setting. We have therefore evaluated the long-term impact of HDV viremia on liver-related outcomes in a nationwide cohort of patients with hepatitis B and D co-infection, cared for at secondary care centers in Sweden. APPROACH AND RESULTS: In total, 337 patients with anti-HDV positivity, including 233 patients with HDV RNA viremia and 91 without HDV viremia at baseline, were retrospectively studied, with a mean follow-up of 6.5 years (range, 0.5-33.1). The long-term risks for liver-related events (i.e., hepatocellular carcinoma [HCC], hepatic decompensation, or liver-related death/transplantation) were assessed, using Cox regression analysis. The risk for liver-related events and HCC was 3.8-fold and 2.6-fold higher, respectively, in patients with HDV viremia compared with those without viremia, although the latter was not statistically significant. Among patients with HDV viremia with no baseline cirrhosis, the cumulative risk of being free of liver cirrhosis or liver-related events was 81.9% and 64.0% after 5 and 10 years of follow-up, respectively. This corresponds to an incidence rate of 0.04 cases per person-year. CONCLUSIONS: HDV RNA viremia is associated with a 3.8-fold higher risk for liver-related outcomes. The prognosis was rather poor for patients with HDV viremia without cirrhosis at baseline, but it was nevertheless more benign than previous estimates from tertiary centers. Our findings may be of importance when making decisions about treatment and evaluating potential outcomes of upcoming antivirals against HDV.
BACKGROUND AND AIMS: Hepatitis delta virus (HDV) infection is associated with fast progression to liver cirrhosis and liver complications. Previous studies have, however, been mainly from tertiary care centers, with risk for referral bias toward patients with worse outcomes. Furthermore, the impact of HDV viremia per se on liver-related outcomes is not really known outside the human immunodeficiency virus co-infection setting. We have therefore evaluated the long-term impact of HDV viremia on liver-related outcomes in a nationwide cohort of patients with hepatitis B and D co-infection, cared for at secondary care centers in Sweden. APPROACH AND RESULTS: In total, 337 patients with anti-HDV positivity, including 233 patients with HDV RNA viremia and 91 without HDV viremia at baseline, were retrospectively studied, with a mean follow-up of 6.5 years (range, 0.5-33.1). The long-term risks for liver-related events (i.e., hepatocellular carcinoma [HCC], hepatic decompensation, or liver-related death/transplantation) were assessed, using Cox regression analysis. The risk for liver-related events and HCC was 3.8-fold and 2.6-fold higher, respectively, in patients with HDV viremia compared with those without viremia, although the latter was not statistically significant. Among patients with HDV viremia with no baseline cirrhosis, the cumulative risk of being free of liver cirrhosis or liver-related events was 81.9% and 64.0% after 5 and 10 years of follow-up, respectively. This corresponds to an incidence rate of 0.04 cases per person-year. CONCLUSIONS: HDV RNA viremia is associated with a 3.8-fold higher risk for liver-related outcomes. The prognosis was rather poor for patients with HDV viremia without cirrhosis at baseline, but it was nevertheless more benign than previous estimates from tertiary centers. Our findings may be of importance when making decisions about treatment and evaluating potential outcomes of upcoming antivirals against HDV.
Authors: Antonella Olivero; Chiara Rosso; Alessia Ciancio; Maria Lorena Abate; Aurora Nicolosi; Giulia Troshina; Angelo Armandi; Davide Giuseppe Ribaldone; Giorgio Maria Saracco; Elisabetta Bugianesi; Mario Rizzetto; Gian Paolo Caviglia Journal: Biomedicines Date: 2022-03-29
Authors: Mathias Jachs; Teresa Binter; Caroline Schmidbauer; Lukas Hartl; Michael Strasser; Hermann Laferl; Stephanie Hametner-Schreil; Alexander Lindorfer; Kristina Dax; Rudolf E Stauber; Harald H Kessler; Sebastian Bernhofer; Andreas Maieron; Lorin Loacker; Simona Bota; Isabel Santonja; Petra Munda; Mattias Mandorfer; Markus Peck-Radosavljevic; Heidemarie Holzmann; Michael Gschwantler; Heinz Zoller; Peter Ferenci; Thomas Reiberger Journal: United European Gastroenterol J Date: 2021-12-07 Impact factor: 4.623
Authors: Carla Osiowy; Ken Swidinsky; Sarah Haylock-Jacobs; Matthew D Sadler; Scott Fung; David Wong; Gerald Y Minuk; Karen E Doucette; Philip Wong; Edward Tam; Curtis Cooper; Alnoor Ramji; Mang Ma; Carmine Nudo; Keith Tsoi; Carla S Coffin Journal: JHEP Rep Date: 2022-02-22