Role of hepatitis D virus in persistent alanine aminotransferase abnormality among chronic hepatitis B patients treated with nucleotide/nucleoside analogues

Journal of the Formosan Medical Association

Yu-Ju Wei¹  Pei-Chien Tsai²  Po-Yao Hsu³  Shu-Chi Wang⁴  Ming-Lun Yeh⁵  Ching-Chih Lin⁶  Chung-Feng Huang⁷  Ching-I. Huang⁸  Jee-Fu Huang⁹  Meng-Hsuan Hsieh^1,10  Shu-Fen Liu^1,10  Ming-Lung Yu^1,11  Po-Cheng Liang^1,12  Yu-Min Ko^1,12  Kuan-Yu Chen^1,12  Wan-Long Chuang^1,12  Yi-Hung Lin^1,12  Zu-Yau Lin^1,12  Tyng-Yuan Jang^1,12  Chia-Yen Dai^1,12  Yi-Shan Tsai^1,12  Shinn-Cherng Chen^1,12  Cheng-Ting Hsu^1,12  Ta-Wei Liu^1,13 

[1] Department of Internal Medicine, Pingtung Hospital, Ministry of Health and Welfare, Ping-Tung, Taiwan;Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;Faculty of Internal Medicine and Hepatitis Research Center, School of Medicine, College of Medicine, and Center for Cancer Research and Liquid Biopsy, Kaohsiung Medical University, Kaohsiung, Taiwan;Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;Health Management Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;Hepatobiliary Laboratory, Hepatobiliary Division, Department of Internal Medicine, Taiwan;Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan;Center for Liquid Biopsy, Kaohsiung Medical University, Kaohsiung, Taiwan;Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan;Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan;Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;Hepatobiliary Laboratory, Hepatobiliary Division, Department of Internal Medicine, Taiwan;

关键词: ALT normalization;    HDV;    NAs;    HBV;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: The biochemical response is a crucial indicator of prognosis in chronic hepatitis B (CHB) patients treated with nucleotide/nucleoside analogues (NAs). The impact of hepatitis D virus (HDV) infection on alanine aminotransferase normalization is elusive. Methods: The longitudinal study recruited 1185 CHB patients who received NAs. These patients were tested for anti-HDV antibody and HDV RNA at the initiation of anti-hepatitis B virus (HBV) therapy and annually for patients who were HDV-seropositive. ALT levels were examined at the first and second year of anti-HBV therapy. ALT abnormality was defined as ALT levels above 40 IU/mL in both male and female, and the risk factors associated with ALT abnormality were analysed. Results: Rates of seropositivity for anti-HDV and HDV RNA were 2.0% and 0.8% among 1185 NA-treated CHB patients, respectively. The strongest factor associated with ALT abnormality (>40 IU/mL) after first year treatment with NAs was HDV RNA seropositivity at year 1 (odds ratio [OR]/95% confidence interval [CI]: 31.44/3.49–283.56, P = 0.002), followed by liver cirrhosis (2.18/1.51–3.15, P < 0.001), detectable HBV DNA at year 1 (OR/CI: 1.99/1.36–2.92, P < 0.001), diabetes (OR/CI: 1.75/1.10–2.78, P = 0.02), body mass index (BMI) (OR/CI: 1.13/1.09–1.18, P < 0.001) and age (OR/CI: 0.97/0.96–0.98, P < 0.001). Among patients who were seronegative for HBV DNA at year 1, the strongest factor associated with ALT abnormality was HDV RNA seropositivity at year 1 (OR/CI: 30.00/3.28–274.05, P = 0.003), followed by liver cirrhosis (OR/CI: 1.83/1.21–2.75, P = 0.004), BMI (OR/CI: 1.16/1.11–1.21, P < 0.001) and age (OR/CI: 0.97/0.96–0.99, P < 0.001). Similarly, the impact of HDV RNA seropositivity on ALT abnormality was noted in patients without detectable HBV DNA but not in those with hepatitis B viremia at treatment year 2 (OR/CI: 10.16/1.33–77.74, P = 0.03). Conclusion: HDV infection played an important role in ALT abnormality in CHB patients receiving 1-year and 2-year NAs. The impact was particularly noted in patients who had successfully suppressed HBV DNA.

【 授权许可】

Unknown