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

JOURNAL OF HEPATOLOGY

卷:66

Article

Beguelin, Charles¹  Moradpour, Darius²  Sahli, Roland³  Suter-Riniker, Franziska⁴  Luthi, Alexander⁴  Cavassini, Matthias⁵  Gunthard, Huldrych F.^6,7  Battegay, Manuel⁸  Bernasconi, Enos⁹  Schmid, Patrick¹⁰  Calmy, Alexandra¹¹  Braun, Dominique L.^6,7  Furrer, Hansjakob¹  Rauch, Andri¹  Wandeler, Gilles^1,12 

[1] Univ Bern, Univ Hosp Bern, Dept Infect Dis, Bern, Switzerland

[2] Univ Lausanne, CHU Vaudois, Div Gastroenterol & Hepatol, Lausanne, Switzerland

[3] Univ Lausanne, CHU Vaudois, Inst Microbiol, Lausanne, Switzerland

[4] Univ Bern, Inst Infect Dis, Fac Med, Bern, Switzerland

[5] Univ Lausanne, Univ Lausanne Hosp, Div Infect Dis, Lausanne, Switzerland

[6] Univ Zurich, Univ Zurich Hosp, Div Infect Dis & Hosp Epidemiol, Zurich, Switzerland

[7] Univ Zurich, Inst Med Virol, Zurich, Switzerland

[8] Univ Basel Hosp, Div Infect Dis & Hosp Hyg, Basel, Switzerland

[9] Reg Hosp Lugano, Div Infect Dis, Lugano, Switzerland

[10] Cantonal Hosp St Gallen, Div Infect Dis & Hosp Epidemiol, St Gallen, Switzerland

[11] Univ Geneva, Univ Hosp Geneva, Div Infect Dis, Geneva, Switzerland

[12] Univ Bern, Inst Social & Prevent Med, Bern, Switzerland

关键词: Hepatitis delta virus;    Human immunodeficiency virus;    Coinfection;    Prevalence;    Mortality;    Clinical;    Outcome;   

DOI  :  10.1016/j.jhep.2016.10.007

来源: Elsevier

【 摘 要 】

Background & 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 hepatitis B surface antigen 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 hepatitis B surface antigen tests, 771 (94%) had a stored serum sample available and were included. The prevalence of HDV infection was 15.4% (119/771, 95% 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 (60.6% vs. 9.1%) and to have a positive hepatitis C virus (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 persons who inject drugs or HCV-coinfected patients were excluded from the analyses. Conclusions: The prevalence of HDV in hepatitis B surface antigen-positive patients in the Swiss HIV Cohort Study (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, eight times more likely to die from a liver-related cause and nine 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. (C) 2016 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

【 授权许可】

Free