Distinct histological patterns in chronic hepatitis D with nucleos(t)ide analogue therapy

Frontiers in Medicine

Medicine

Jeffrey S. Glenn¹  David E. Kleiner²  Theo Heller³  Christopher Koh³  Julian Hercun³ 

[1] Departments of Medicine (Division of Gastroenterology and Hepatology) and Microbiology & Immunology, Stanford University School of Medicine, Stanford, CA, United States;NCI Laboratory of Pathology, National Institutes of Health, Bethesda, MD, United States;Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States;

关键词: viral hepatitis;    hepatitis D (delta) virus;    nucleoside analog;    histology;    hepatitis B virus;   

DOI  :  10.3389/fmed.2023.1082069

 received in 2022-10-27, accepted in 2023-03-17,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundChronic hepatitis delta virus (HDV) infection leads to a more severe hepatitis than hepatitis B virus (HBV) infection alone. Specific histological staining patterns have been described in HBV mono-infection, however this has not been extensively investigated in HDV co-infection. This study evaluated whether the use of nucleos(t)ide analogs (NAs) for concurrent HBV infection has an impact on the histological appearance of chronic HDV.MethodsLiver biopsies of all patients referred for management of HDV infection were reviewed and hepatitis-specific stains for HBV antigens were evaluated. Clinical and histological characteristics were compared between patients on and off-NA therapy.Results50 patients were included in our analysis, of which 26 (52%) were on NA therapy at the time of the biopsy. Overall, 8% stained for HBV core antigen and 86% stained for HBV surface antigen. On and off-NA groups had similar degrees of fibrosis and inflammation, however NA patients had an odds ratio of 7.15 for membranous staining and 0.13 for scattered granular staining (p = 0.001). No association was found with markers of disease severity or viral activity, with nonetheless a lower score of total inflammation noted in biopsies with a positive membranous stain (8.5 vs. 10.3 p = 0.04).ConclusionIn chronic HDV infection, patients treated with nucleos(t)ide analogs demonstrate a unique membranous staining pattern for hepatitis B surface antigen, which is not associated with HBV or HDV replicative activity. These findings may help improve the understanding of the role of HBV directed therapy in HDV pathophysiology.HighlightsHistological staining is associated with viral activity in chronic HBV, however this has been infrequently explored in HDV. In HDV, staining patterns differ based on HBV treatment status and do not appear to be associated with markers of viral activity.

【 授权许可】

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Copyright © 2023 Hercun, Heller, Glenn, Kleiner and Koh.