Highlights
- •Patients of African origin who contract HDV less often have cirrhosis.
- •Patients with HDV and detectable viral load have worse clinical outcomes.
- •Patients with HDV genotype 5 less often develop hepatic decompensation.
- •Patients with HDV genotype 5 seem to respond better to peg-IFN treatment.
Background & Aims
Coinfection with HDV causes rapid progression to liver cirrhosis and hepatic decompensation
in patients with chronic hepatitis B. Factors that are associated with disease progression
are poorly understood. In this study we aim to identify risk factors associated with
disease progression and better characterise clinical differences and treatment response
between HDV genotype 1 and 5.
Methods
In this retrospective study, all patients under our care between 2005 and 2016 with
HBV/HDV coinfection (HBsAg+, anti-HDV antibodies positive) were analysed. Patients
were excluded if follow-up was less than 6 months, if they had HCV and/or HIV coinfection
or an acute HDV infection. Demographic data, stage of liver disease, development of
liver complications and treatment response were recorded.
Results
One-hundred seven patients (mean age 36.0 years, 57% male) were followed for a median
period of 4.4 years (range 0.6–28.1 years); 64% were of African origin and 17% were
of European origin, with 28% of patients being cirrhotic at first visit; 43% patients
had actively replicating HDV virus (anti-HDV-IgG+, anti-HDV-IgM+ or HDV RNA+) and
57% of patients were HDV exposed (anti-HDV-IgG+, HDV RNA-). Patients with actively
replicating HDV more often developed liver complications than HDV-exposed patients
(p = 0.002), but no differences in baseline characteristics were observed. Patients
with HDV genotype 5 less often developed cirrhosis or hepatic decompensation compared
to patients with HDV genotype 1. Twenty-four patients were treated with peg-IFN and
post-treatment response was significantly better in patients infected with genotype
5 (10% GT1 vs. 64% GT5, p = 0.013).
Conclusion
Patients infected with HDV genotype 5 appear to have a better prognosis with fewer
episodes of hepatic decompensation and better response to peg-IFN treatment than patients
infected with HDV genotype 1.
Lay summary
Hepatitis delta is a virus that affects the liver. The virus is known to have different
subtypes, called genotypes. With this research we discovered that hepatitis delta
virus genotype 1 behaves differently than genotype 5 and causes faster development
of liver disease. This is important for education of our patients and to determine
how often we need to check our patients.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: January 22, 2020
Accepted:
December 31,
2019
Received in revised form:
December 29,
2019
Received:
March 5,
2019
Footnotes
Author names in bold designate shared co-first authorship
Identification
Copyright
© 2020 Published by Elsevier B.V. on behalf of European Association for the Study of the Liver.
