Long‐term clinical outcomes in patients with chronic hepatitis delta: the role of persistent viraemia

Abstract

Summary Background Chronic hepatitis delta is a severe liver disease with rapid progression to cirrhosis. The impact of hepatitis delta virus (HDV)‐RNA on disease progression and interferon treatment in a real‐world cohort has been barely explored. Aim To assess the development of clinical events in a cohort of chronic hepatitis delta patients according to the presence or absence of HDV‐RNA Methods Multicentre study at four academic hospitals in Spain included anti‐HDV‐positive patients with compensated liver disease with a follow‐up ≥12 months. Results Among 2888 HBsAg‐positive subjects, 151 (5.2%) tested positive for anti‐HDV, and 118 were included (58% men; median age, 49 years; 73% detectable HDV‐RNA and 30% cirrhosis, most often in subjects with HDV‐RNA). After a median follow‐up of 8 years, subjects with initially detectable HDV‐RNA were more prone to developing cirrhosis (31% vs 0%, P = .002) and/or liver decompensation (28% vs 3%, P = .019). Mortality rate was 0.44 per 1000 person‐months. The probability of a clinical event was 6%, 25%, and 80% according to initial baseline‐event‐anticipation score. HDV‐RNA became undetectable in 21 (24%) subjects either due to interferon or spontaneously (48% vs 52%, P = .29). Liver decompensation was reduced in interferon‐treated patients (13% vs 38%, P = .026). Conclusions Subjects with persistently positive HDV‐RNA had a worse prognosis in terms of clinical events. Baseline‐event‐anticipation score is useful in predicting the risk of developing liver decompensation and hepatocellular carcinoma. Interferon was beneficial in reducing liver decompensation, even in the absence of virological response.

Petabase-scale sequence alignment catalyses viral discovery

“…Alone, HDV is unable to produce infectious viral particles, as it requires the envelope protein from its helper virus, Hepatitis B (HBV) [19]. HDV infection aggravates liver cirrhosis caused by HBV and worsens clinical outcomes [20].…”

Editorial: rapid disease progression in hepatitis delta—can we turn the tide? Authors' reply

“…In our cohort, 30% of subjects presented signs of cirrhosis already at baseline, and 27% progressed to cirrhosis within follow‐up. Several studies including ours have shown that the presence of hepatitis delta viremia is the main factor associated with development of clinical events …”

“…The authors' declarations of personal and financial interests are unchanged from those in the original article …”

“…We thank Drs Sonnenveld and De Knegt for their insightful comments on our recent article . Chronic hepatitis delta is often undiagnosed particularly in HBeAg‐negative patients with low levels of hepatitis B virus (HBV) DNA and normal or almost normal ALT, features that mimic, as they pointed out, the HBV inactive state.…”

Editorial: rapid disease progression in hepatitis delta—can we turn the tide?

“…Palom et al recently reported the results of a long‐term follow‐up study of patients with chronic hepatitis delta (HDV) enrolled from four academic hospitals in Spain . Their findings illustrate some of the major challenges we face in the management of this deadly disease.…”