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. 2020 Jan 30;20(1):24.
doi: 10.1186/s12876-020-1168-9.

High rates of cirrhosis and severe clinical events in patients with HBV/HDV co-infection: longitudinal analysis of a German cohort

Jan-Hendrik Bockmann  1   2 , Marcel Grube  3 , Vanessa Hamed  3 , Johann von Felden  3 , Johanna Landahl  3 , Malte Wehmeyer  3 , Katja Giersch  3 , Michaela T Hall  4   5 , John M Murray  4   5 , Maura Dandri  3   6 , Stefan Lüth  3   7 , Ansgar W Lohse  3   6 , Marc Lütgehetmann  3   8 , Julian Schulze Zur Wiesch  3   6
Affiliations

High rates of cirrhosis and severe clinical events in patients with HBV/HDV co-infection: longitudinal analysis of a German cohort

Jan-Hendrik Bockmann et al. BMC Gastroenterol. .

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.

Keywords: Cirrhosis; HBV; HCC; HDV; Interferon; Outcome; RNA.

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Conflict of interest statement

JSZW has previously served as a speaker for Roche and Gilead.

Figures

Fig. 1
Fig. 1
Patient outcome of Hepatitis D patients. Severe clinical events included death, HCC development and liver transplantation
Fig. 2
Fig. 2
Virological and biochemical courses of 3/18 patients responding to IFN therapy by serum HDV RNA, HBV DNA, HBsAg and ALT levels
See this image and copyright information in PMC

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