Epidemiological trends of HBV and HDV coinfection among Viennese HIV+ patients

Abstract

Background and Aims Despite vaccination recommendations, hepatitis B (HBV) and D (HDV) coinfections are common in HIV+individuals. Methods HBV immunization status (anti‐HBs) as well as HBV (HBsAg/HBV‐DNA) and HDV (anti‐HDV) coinfection rates were assessed in 1870 HIV+individuals at HIV diagnosis (baseline, BL) and last follow‐up (FU). Results Sixty‐eight (3.6%) HIV patients were never tested for HBV. At BL, 89/1802 (4.9%) HIV patients were HBV coinfected. Four hundred and fifteen (23.0%) showed virological HBV clearance [HBsAg(‐)/anti‐HBc(+)/anti‐HBs(+)] and 210 (11.7%) presented with anti‐HBc(+) only. Seven hundred and ten (39.4%) were HBV naïve [HBsAg(‐)/anti‐HBs(‐)/anti‐HBc(‐)/HBV‐DNA(‐)], but only 378 (21.0%) received vaccinations with detectable anti‐HBs(+) titres. Among the 89 HBV/HIV‐coinfected patients, only 52 (58.4%) were tested for HDV: 11/49 (22.4%) had anti‐HDV(+) and 3/12 (25.0%) showed HDV‐RNA viraemia. During a median FU of 6.5 (IQR 7.2) years, 44 (4.6%) of the 953 retested BL HBV‐negative patients acquired new HBV infection (including 15/304, 4.9% of vaccinated patients). Of the 89 patients, 22 (24.7%) patients cleared their HBsAg, resulting in 60/1625 (3.7%) HIV/HBV individuals at FU: 34 (56.7%) showed HBV‐DNA suppression and 15 (25.0%) were HBV viraemic, while 12/89 (13.5%) remained without a FU test. Vaccinations induced anti‐HBs(+) in 137 of the retested 649 (21.1%) BL HBV‐naïve patients. Conclusion HBV testing is well established among Viennese HIV+patients with HBV coinfection rates around 4%‐5%. HBV vaccinations are insufficiently implemented since anti‐HBs titres were detected in only 21.1% of HBV‐naive HIV(+) patients and new HBV infections occurred in previously vaccinated patients. HDV testing is not systematically performed despite up to 25% of HIV/HBV patients may show HDV coinfection.

The cascade of care for patients with chronic hepatitis delta in Southern Stockholm, Sweden for the past 30 years

“…23 Importantly in this study 4.9% of HBV vaccinated PLHIV acquired de-novo HBV infection during a median of 6.5 years follow-up, highlighting the challenges for HBV and HDV screening in the PLHIV population. 23 While different liver societies recommend screening persons with HBV/HDV for HIV co-infection, the reciprocal recommendation in HIV societies might not be enough emphasized. 34 Changes in screening practices across different disciplines of care have been demonstrated (primary care and gastroenterology care) 19 and possibly might reflect a low awareness of HDV as the least common among chronic hepatides.…”

“…Low frequency of HDV screening has been also noted in people living with HIV (PLHIV) and HBV, 13,22 where only 58.4% ( n = 52/89) underwent at least one anti‐HDV test in an Austrian study enrolling 1870 PLHIV 23 . Patients with anti‐HDV positivity lacked in 60% of cases a known risk factor of transmission in a Spanish study, and 18% did not meet any of the AASLD criteria in a US study 13,19 .…”

“…Analysis of a nationwide prospective cohort of PLHIV (ICONA cohort), 61% had not been screened for HDV and with decreasing frequency of screening from 1997 to 2015 33 . In an Austrian study, 58.4% of PLHIV with HBV co‐infection were not screened for HDV 23 . Importantly in this study 4.9% of HBV vaccinated PLHIV acquired de‐novo HBV infection during a median of 6.5 years follow‐up, highlighting the challenges for HBV and HDV screening in the PLHIV population 23 .…”

“…In an Austrian study, 58.4% of PLHIV with HBV co‐infection were not screened for HDV 23 . Importantly in this study 4.9% of HBV vaccinated PLHIV acquired de‐novo HBV infection during a median of 6.5 years follow‐up, highlighting the challenges for HBV and HDV screening in the PLHIV population 23 . While different liver societies recommend screening persons with HBV/HDV for HIV co‐infection, the reciprocal recommendation in HIV societies might not be enough emphasized 34 .…”

Immediate-type hypersensitivity reaction to bulevirtide and successful desensitization in a patient with HBV/HDV-associated compensated cirrhosis

“…1 Importantly, HDV-related liver disease progression and complications will constitute the major prognostic factor in most HBV/HDV-coinfected individuals. [7][8][9][10] BLV, which is marketed as a soluble powder, does not contain any other potential allergens aside from BLV itself. 1 While several mechanisms have been proposed to cause immediate-type hypersensitivity reactions, IgE-mediated hypersensitivity remains the "typical" pathway for type-I reaction.…”