The Severity of Hepatitis D in Young Adults of Age 18-25 Years

Abstract

Background Current literature on the prevalence and characteristics of hepatitis D virus (HDV) infection in young adults is limited. This study aims to determine the disease characteristics and severity in young adults. Methods The case records of HDV RNA positive patients of age 18-25 years were analyzed. Results Out of 119 patients, 105 (88%) patients were male. HBV-DNA was detectable in 83 (70%). Hepatitis B eantigen (HBeAg) was non-reactive in 99 (83%). Cirrhosis was identified in 45 (37.8%) individuals; nine (7.5%) were classified as Child class B or Child class C. Twenty-four (20.2%) had a Model For End-Stage Liver Disease (MELD) score of ≥10, out of these 16 had a score of 15 or more. The risk of decompensation was calculated according to the Baseline-event-anticipation (BEA) score; eight (6.7%) patients were at BEA-A (mild risk), 105 (88.2%) were at BEA-B (moderate risk), and six (5.0%) were at BEA-C (severe risk). Notable findings in patients with cirrhosis included splenomegaly, low total leucocyte counts, low platelets, high bilirubin, elevated aspartate aminotransferase, gamma-glutamyl transferase and international normalization ratio, low albumin, high AST to Platelet Ratio Index (APRI), and high BEA score. The splenic size, platelet count, and albumin levels were independently associated with cirrhosis (p < 0.001, <0.001, and 0.003). A model using a combination of platelet count, albumin, and spleen size was developed to accurately predict cirrhosis in this cohort. It had an area under the receiver operating characteristics (AUROC) of 0.935. Conclusions HDV-infected young adults, age 18-25 years, were at moderate to severe risk of disease progression. About one-third of patients had already developed cirrhosis indicating the aggressive nature of the disease.

An Insight Into the Factors Affecting the Prevalence and Natural History of Hepatitis D

“…Young adults (18-25) have also been shown to be at severe risk of disease progression. Approximately a third of patients had cirrhosis at presentation, suggesting an aggressive course of disease [ 59 ]. HBV DNA was detectable in 70% of the cases, indicating a preponderance of codominant infections.…”

“…A three-variable model based on spleen size, albumin level, and platelet count and a two-variable model based on spleen size and platelet count can be used to predict clinical outcomes in young adults with HDV infection [ 59 ].…”

Hepatitis delta virus: From infection to new therapeutic strategies

“…It may present either as an exacerbation of a known chronic hepatitis B status accompanied by hepatic decompensation, or as a new acute hepatitis status in asymptomatic HBsAg carriers[ 35 ]. Super-infection usually leads to a chronic infection (in > 90% of cases), with rapid progression to cirrhosis[ 23 , 38 - 40 ]. Diagnosis of the super-infection is based upon a positive test for anti-HD IgM and a negative test for anti-HBc IgM in HBsAg carriers[ 35 , 37 ].…”

“…A similar score called the “delta Fibrosis Score” considers GGT along with age, albumin and serum cholinesterase[ 46 ]. Abbas et al [ 40 ] proposed to simply use spleen size and platelet count as the predictive parameters of cirrhosis. Other non-invasive markers of fibrosis that are in use clinically include components of the extracellular matrix, namely procollagen III N-peptide, collagen IV, and hyaluronic acid; however, these factors have lower diagnostic accuracy than in other forms of chronic hepatitis[ 35 ].…”

“…In addition, experiments in transgenic mice expressing HDAg proteins seem to rule out a direct carcinogenic role of HDV[ 3 ]; however, the L-HDAg may promote oxidative stress through activation of signal transducer and transcription-3 and nuclear factor-kappa B, factors vital to cancer cell communication and carcinogenesis. Moreover, it may also promote cancer cell survival through epigenetic mechanisms, such as DNA methylation of the tumour suppressor gene and acetylation of histone H3 of the clustering promoter[ 40 ].…”