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Multicenter Study
. 2021 Dec;9(10):1119-1127.
doi: 10.1002/ueg2.12163. Epub 2021 Dec 7.

Hepatitis D virus (HDV) prevalence in Austria is low but causes considerable morbidity due to fast progression to cirrhosis

Mathias Jachs  1   2 , Teresa Binter  1   2 , Caroline Schmidbauer  2   3 , Lukas Hartl  1   2 , Michael Strasser  4 , Hermann Laferl  5 , Stephanie Hametner-Schreil  6 , Alexander Lindorfer  6 , Kristina Dax  7 , Rudolf E Stauber  8 , Harald H Kessler  9 , Sebastian Bernhofer  10 , Andreas Maieron  10 , Lorin Loacker  11 , Simona Bota  12 , Isabel Santonja  13 , Petra Munda  1 , Mattias Mandorfer  1   2 , Markus Peck-Radosavljevic  12 , Heidemarie Holzmann  13 , Michael Gschwantler  2   3 , Heinz Zoller  14 , Peter Ferenci  1 , Thomas Reiberger  1   2
Affiliations
Multicenter Study

Hepatitis D virus (HDV) prevalence in Austria is low but causes considerable morbidity due to fast progression to cirrhosis

Mathias Jachs et al. United European Gastroenterol J. 2021 Dec.

Abstract

Background: Hepatitis D virus (HDV) coinfection aggravates the course of hepatitis B virus (HBV). The prevalence of HDV in Austria is unknown.

Objective: This national study aimed at (i) recording the prevalence of HDV-infection in Austria and (ii) characterizing the "active" HDV cohort in Austria.

Methods: A total of 10 hepatitis treatment centers in Austria participated in this multicenter study and retrospectively collected their HDV patients between Q1/2010 and Q4/2020. Positive anti-HDV and/or HDV-RNA-polymerase chain reaction (PCR) results were retrieved from local database queries. Disease severity was assessed by individual chart review. Viremic HDV patients with clinical visits in/after Q1/2019 were considered as the "active" HDV cohort.

Results: A total of 347 anti-HDV positive patients were identified. In 202 (58.2%) patients, HDV-RNA-PCR test was performed, and 126/202 (62.4%) had confirmed viremia. Hepatocellular carcinoma was diagnosed in 7 (5.6%) patients, 7 (5.6%) patients underwent liver transplantation, and 11 (8.7%) patients died during follow-up. The "active" Austrian HDV cohort included 74 (58.7%) patients: Evidence for advanced chronic liver disease (ACLD, i.e., histological F3/F4 fibrosis, liver stiffness ≥10 kPa, varices, or hepatic venous pressure gradient ≥6 mmHg) was detected in 38 (51.4%) patients, including 2 (5.3%) with decompensation (ascites/hepatic encephalopathy). About 37 (50.0%) patients of the "active" HDV cohort had previously received interferon treatment. Treatment with the sodium-taurocholate cotransporting polypeptide inhibitor bulevirtide was initiated in 20 (27.0%) patients.

Conclusion: The number of confirmed HDV viremic cases in Austria is low (<1% of HBV patients) but potentially underestimated. Testing all HBV patients will increase the diagnostic yield. More than half of viremic HDV patients had ACLD. Improved HDV testing and workup strategies will facilitate access to novel antiviral therapies.

Keywords: epidemiology; hepatitis D; viral hepatitis.

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Conflict of interest statement

Caroline Schmidbauer received travel support from Gilead, Abbvie and Gebro; and speaking honoraria from Abbvie. Stephanie Hametner‐Schreil received speaking honoraria and/or advisory board fees from: Gilead, Abbvie, Shionogi, Astellas, Intercept, Roche. Petra Munda received speaking honoraria from AbbVie, Gilead, MSD, Janssen, Roche, Intercept; travel support from AbbVie and Gilead; and consulting/advisory board fees from AbbVie, Gilead, MSD, Janssen, Roche and Intercept. M.M. served as a speaker and/or consultant and/or advisory board member for AbbVie, Bristol‐Myers Squibb, Gilead, Collective Acumen, and W. L. Gore & Associates and received travel support from AbbVie, Bristol‐Myers Squibb, and Gilead. M.P.‐R. received advisory and/or speaker honoraria from AstraZeneca, AbbVie, Amgen, Bayer, Behring, BMS, Eisai, Gilead, Intercept, Ipsen, Lilly, Merz, MSD, Roche, Sanofi, Shionogi, Sobi. M.G. received grants from AbbVie, Gilead, and MSD; speaking honoraria from AbbVie, Gilead, MSD, Janssen, Roche, Intercept; and consulting/advisory board fees from AbbVie, Gilead, MSD, Janssen, Roche and intercept. Peter Ferenci received an unrestricted research grant from Gilead, is on the safety review board of MyrPharma, consulting/advisory board fees from Viravaxx, speaking honoraria from AbbVie, Gilead. T.R. served as a speaker and/or consultant and/or advisory board member for AbbVie, Bayer, Boehringer Ingelheim, Gilead, Intercept, MSD, Siemens, and W. L. Gore & Associates and received grants/research support from AbbVie, Boehringer Ingelheim, Gilead, MSD, Philips, and W.L. Gore & Associates as well as travel support from Boehringer Ingelheim and Gilead. Mathias Jachs, Teresa Binter, Lukas Hartl, Michael Strasser, Hermann Laferl, Alexander Lindorfer, Kristina Dax, Rudolf E. Stauber, Harald H. Kessler, Sebastian Bernhofer, Andreas Maieron, Lorin Loacker, Simona Bota, Isabel Santonja, and Heidemarie Holzmann declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Study cohort flowchart. ACLD, advanced chronic liver disease; HDV, hepatitis D virus; PCR, polymerase chain reaction; RNA, ribonucleic acid. *Data on disease severity available in n = 35/76 non‐viremic patients
FIGURE 2
FIGURE 2
Year of HDV diagnosis in the viremic cohort
FIGURE 3
FIGURE 3
Kaplan–Meier curves depicting (a) the time until the composite endpoint comprising liver‐related death/transplantation/development of hepatocellular carcinoma and (b) overall survival time stratified by the presence/absence of hepatitis D virus‐related advanced chronic liver disease at baseline
FIGURE 4
FIGURE 4
Distribution of fibrosis stages within the “active” Austrian hepatitis D virus cohort
See this image and copyright information in PMC

Comment in

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