HDV RNA levels &lt;1000 IU/ml and total anti-HDV titers &lt;1:1000 identify chronic hepatitis D subjects without active liver disease

Ricco, G.; Cavallone, D.; Colombatto, P.; Oliveri, Filippo; Coco, B.; Romagnoli, V.; Surace, L.; Salvati, A; Bonino, Ferruccio; Brunetto, M.R.

doi:10.1016/s0168-8278(23)03199-9

Cited by 1 publication

(4 citation statements)

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“…26 Further, looking at HDV, among HIV-uninfected individuals it has been demonstrated a correlation between HDV viral load, with a cut-off of 1000 IU/mL and outcome. 10,11,27 Our data suggest that among PLWH, even in the presence of low levels of HDV replication, a substantial risk of evolution towards decompensated liver disease or HCC does persist. This could be related to the additional effects of immune suppression and to the HCV coinfection.…”

Section: Discussionmentioning

confidence: 76%

“…This could be related to the additional effects of immune suppression and to the HCV coinfection. As a consequence, it could be hypothesised that in PLWH a partial suppression of HDV replication is not necessarily associated with a better prognosis, as in HIV‐uninfected persons, 11,27 and that treatment‐induced 2 log decrease of HDV‐RNA levels could be a less solid end‐point for effective treatment of HDV in PLWH.…”

Section: Discussionmentioning

confidence: 99%

“…Higher HDV‐RNA levels have been shown to be associated with a higher risk of progression of liver disease in HIV‐uninfected persons 10 . For these reasons, low HDV‐RNA levels have been identified as a positive prognostic factor 11 and reaching HDV‐RNA below 1000 copies/mL has been considered a surrogate marker of effective treatment in Delta hepatitis 12 . In PLWH the relationship between HDV‐RNA levels and prognosis has never been assessed.…”

Section: Introductionmentioning

confidence: 99%

“…9 Higher HDV-RNA levels have been shown to be associated with a higher risk of progression of liver disease in HIV-uninfected persons. 10 For these reasons, low HDV-RNA levels have been identified as a positive prognostic factor 11 and reaching HDV-RNA HDV Ab, HDV-RNA and HDV genotypes were tested. Primary end-point: time from first HDV screening to Severe Liver Related Events (SLRE: decompensated cirrhosis, liver transplantation, HCC).…”

Section: Introductionmentioning

confidence: 99%

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Determinants of worse liver‐related outcome according to HDV infection among HBsAg positive persons living with HIV: Data from the ICONA cohort

d’Arminio Monforte,

Tavelli,

Salpini

et al. 2023

Liver International

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ObjectivesWe aimed to study hepatitis D virus (HDV) prevalence and risk of progression to severe liver‐related events (SLRE) in HBsAg positive people living with HIV (PLWH) in Italy; role of HDV‐RNA copy levels, HCV coinfection and nadir CD4 counts were also investigated.MethodsPeople living with HIV (PLWH) from Italian Foundation cohort Naïve antiretrovirals (ICONA) with available HBsAg and HDV Ab were enrolled. HBsAg, HDV Ab, HDV‐RNA and HDV genotypes were tested. Primary end‐point: time from first HDV screening to Severe Liver Related Events (SLRE: decompensated cirrhosis, liver transplantation, HCC). Fine‐grey regression models were used to evaluate the association of HDV Ab, HDV‐RNA, HDV/HCV coinfection, CD4 nadir and outcome. Secondary end‐points: time to SLRE or death; HDV Ab and HDV‐RNA prevalence.ResultsA total of 152/809 (18.8%) HBsAg positive PLWH showed HDV Ab reactivity; 63/93 (67.7%) were HDV‐RNA positive. Being male, persons who inject drugs (PWID), HCV Ab positive, with FIB‐4 > 3.25 were independent factors of HDV Ab positivity. In a median follow‐up of 5 years, 37 PLWH (4.1% at 5‐year) developed SLRE and 97 (12.0%) reached the SLRE or death end‐point. HDV‐RNA positive (independently from HDV‐RNA copy level) PLWH had a 4.6‐fold (95%CI 2.0–10.5) higher risk of SLRE than HDV negatives. PLWH positive for both HCV Ab and HDV Ab showed the highest independent risk of SLRE (ASHR: 11.9, 95%CI: 4.6–30.9 vs. HCV neg/HDV neg). Nadir CD4 < 200/mL was associated with SLRE (ASHR: 3.9, 95% 1.0–14.5).ConclusionsOne‐fifth of the HBsAg positive PLWH harbour HDV infection, and are at high risk of progression to advanced liver disease. HCV contributes to worse outcomes. This population needs urgently effective treatments.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%