Hepatitis delta-associated mortality in HIV/HBV-coinfected patients.

Béguelin, Charles Antoine; Moradpour, Darius; Sahli, Roland; Suter, Franziska Marta; Lüthi, Alexander; Cavassini, Matthias; Günthard, Huldrych F; Battegay, Manuel; Bernasconi, Enos; Schmid, Patrick; Calmy, Alexandra; Braun, Dominique; Furrer, Hansjakob; Rauch, Andri; Wandeler, Gilles (2017). Hepatitis delta-associated mortality in HIV/HBV-coinfected patients. Journal of hepatology, 66(2), pp. 297-303. Elsevier 10.1016/j.jhep.2016.10.007

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BACKGROUND AND 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 HBsAg 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 HBsAg, 771 (94%) had a stored serum sample available and were included. The prevalence of HDV infection was 15.4% (119/771, 95% confidence interval (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 (PWID) (60.6% vs. 9.1%) and to have a positive 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 PWID or HCV-coinfected patients were excluded from the analyses. CONCLUSIONS The prevalence of HDV in HBsAg-positive patients in the 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, 8 times more likely to die from a liver-related cause and 9 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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology
04 Faculty of Medicine > Service Sector > Institute for Infectious Diseases

UniBE Contributor:

Béguelin, Charles Antoine; Suter, Franziska Marta; Lüthi, Alexander; Furrer, Hansjakob; Rauch, Andri and Wandeler, Gilles

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services
500 Science > 570 Life sciences; biology

ISSN:

0168-8278

Publisher:

Elsevier

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

22 Nov 2016 08:49

Last Modified:

15 Oct 2017 02:30

Publisher DOI:

10.1016/j.jhep.2016.10.007

PubMed ID:

27746337

Uncontrolled Keywords:

Clinical Coinfection Hepatitis delta virus Human immunodeficiency virus Mortality Outcome Prevalence

BORIS DOI:

10.7892/boris.89359

URI:

https://boris.unibe.ch/id/eprint/89359

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