Demographics and outcomes of hepatitis B and D: A 10-year retrospective analysis in a Swiss tertiary referral center

Abstract

Background Hepatitis B virus (HBV) is a major global health challenge with approximately 250–350 million chronically infected individuals. An improved understanding of the demographic features and outcomes of chronic HBV infection and hepatitis D virus (HDV) infection in low-endemic areas may improve prevention, early identification and management both at individual and community levels. Here, we retrospectively analyzed the demographic and clinical characteristics, treatment rates and outcomes of adult patients with chronic HBV infection with or without HDV coinfection examined at Lausanne University Hospital, Switzerland over a 10-year period. Methods We analyzed the medical records of all adult patients with chronic HBV and HDV infection examined in our center between 2007 and 2016. Liver-related outcome was defined as the occurrence of cirrhosis, hepatocellular carcinoma, liver transplantation or liver-related death. Analyses were performed using logistic regression and results were reported as odds ratio (OR) and 95% confidence interval (CI). Results Of 672 consecutive patients, 421 (62.6%) were male, median age was 36 years (interquartile range, 28–46 years), and 233 (34.7%) were of African origin. The prevalence of HDV coinfection was 7.1% and the proportion of anti-HDV-positive patients with detectable HDV RNA was 70.0%. In multivariate analysis, HDV coinfection was the strongest predictor for liver-related outcome (OR 6.06, 95% CI 2.93–12.54, p<0.001), followed by HBeAg positivity (OR 2.47, 95% CI 1.30–4.69, p = 0.006), age (OR per 10-year increase 2.03, 95% CI 1.63–2.52, p<0.001) and sex (OR for female 0.39, 95% CI 0.22–0.71, p = 0.002). The predictive accuracy of the multivariate model was high (receiver operator characteristic area under the curve 0.81). Conclusion This retrospective study underscores the importance of migration in the epidemiology of chronic hepatitis B in low-endemic areas. HDV coinfection, HBeAg positivity and age predicted liver-related outcomes while female sex had a protective effect.

Sex‐differences in the association of interleukin‐10 and interleukin‐12 variants with the progression of hepatitis B virus infection in Caucasians

“…In our cohort, male patients are overrepresented in the chronic HBV infection group and more often developed LC. This is in accordance with previous studies in which increased male : female ratios in chronic HBV infection and in HBV‐related LC in white European people are reported 42,43 …”

“…This is in accordance with previous studies in which increased male : female ratios in chronic HBV infection and in HBV-related LC in white European people are reported. 42,43 Detailed mechanisms of this sex dimorphism are still unclear.…”

Natural history of untreated HDV patients: Always a progressive disease?

“…liver cirrhosis and ethnicity or genotype, with some being still debated (Figure 1). 49,66 Predictors were found to be Asian origin, higher FIB‐4 score, and liver cirrhosis in an analysis of 233 patients with HDV RNA positivity in one study, while male sex, age > 40 years, central European or Western European origin, and having positive HBeAg were predictors in another analysis of 46 patients with anti‐HDV positivity 14,67 . Different parameters with possible role or association in the progression of the liver disease, such as HDV/HBV genotypes or ethnicity, HBV/HDV viral pattern, presence of HDV viremia, co‐infection with other viruses, or antiviral therapy are described below.…”

“…FIB-4 score, and liver cirrhosis in an analysis of 233 patients withHDV RNA positivity in one study, while male sex, age > 40 years, central European or Western European origin, and having positive HBeAg were predictors in another analysis of 46 patients with anti-HDV positivity 14,67. Different parameters with possible roleCirrhosis baseline, n = (%…”

Sexual Dimorphism in Chronic Hepatitis B Virus (HBV) Infection: Evidence to Inform Elimination Efforts

“…In humans, females are relatively protected from chronic liver fibrosis, regardless of aetiology, including lower rates of NAFLD/NASH 37 , a lower rate of cirrhosis and liver transplant 38 and a lower risk of hospitalisation and death from cirrhosis 39 compared to males. Pre-menopausal females with CHB are at a lower risk of chronic liver disease compared to males, as exemplified by a cohort of 672 patients in Switzerland, in which liver-related outcomes were significantly less common in females (OR 0.35, 95% CI 0.20-0.60) 40 . Similarly, in a Canadian study of nearly 6000 patients with HBV infection, male sex was an independent predictor of advanced liver fibrosis 41 .…”