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

BMC Gastroenterology

Katja Giersch¹  Vanessa Hamed¹  Marcel Grube¹  Stefan Lüth¹  Johann von Felden¹  Marc Lütgehetmann¹  Malte Wehmeyer¹  Maura Dandri¹  Jan-Hendrik Bockmann¹  Julian Schulze Zur Wiesch¹  Johanna Landahl¹  Ansgar W. Lohse¹  John M. Murray²  Michaela T. Hall² 

[1] 1st Department of Internal Medicine, University Medical Hospital Hamburg-Eppendorf;School of Mathematics and Statistics, UNSW Sydney;

关键词: HBV;    HDV;    HCC;    Interferon;    RNA;    Outcome;   

DOI  :  10.1186/s12876-020-1168-9

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown