Prevalence and predictors for compensated Advanced Chronic Liver Disease (c-ACLD) in patients with chronic Hepatitis Delta Virus (HDV) infection

Abstract

ObjectiveThe study aimed to evaluate the prevalence and predictor factors for compensated advanced chronic liver disease (c-ACLD) in patients with hepatitis Delta virus (HDV) infection.MethodsThis cross-sectional study included consecutive HDV-infected patients defined by positive anti-HDV. Patients with hepatitis C coinfection, liver transplantation or presence of conditions that limit liver (LSM) or spleen stiffness measurement (SSM) were excluded. Blood tests, abdominal ultrasound, SSM and LSM by transient elastography (FibroScan®) were performed at the same day. Alcohol consumption was quantified using the AUDIT score and c-ACLD was defined by LSM ≥ 15 kPa performed by an experimented operator blinded for clinical and laboratory data.Results101 patients were eligible and few patients were excluded due to negative anti-HDV (n = 7), hepatitis C coinfection (n = 2), liver transplantation (n = 10) and limitation for LSM or SSM (n = 5). Therefore, 77 patients [61% male, age = 43 (IQR,36–52) years] were included. The prevalence of c-ACLD was 57% (n = 44/77). Patients with c-ACLD had a higher rate of detectable HBV viral load (p = 0.039), higher levels of transaminases, GGT, alkaline phosphatases, total bilirubin and INR (p<0.001 for all), as well as lower platelet count and albumin levels (p>0.001 for both) compared to those without c-ACLD. Patients with c-ACLD had higher SSM [65.2 (IQR,33.8–75.0) vs 21.8 (16.5–32.0) kPa; p<0.001] and higher splenic volume [475 (IQR,311–746) vs 154 (112–283) cm3; p<0.001] compared to those without. Detectable HBV viral load (>10 UI/ml), alkaline phosphatase (per IU/L) and GGT levels (per IU/L) were independently associated with c-ACLD in all multivariate models. Splenic volume [per cm3,OR = 1.01 (95%CI,1.01–1.02);p = 0.002], SSM [per kPa, OR = 1.04 (1.01–1.07);p = 0.012] and splenomegaly [yes vs no,OR = 28.45 (4.42–182.95);p<0.001] were independently associated with c-ACLD.ConclusionsThe prevalence of c-ACLD was high in patients with chronic HDV infection in western Amazon basin. HBV viral load, liver enzymes and splenic features can be used to predict severe liver disease in HDV-infected patients.

Non‐F HBV/HDV‐3 coinfection is associated with severe liver disease in Western Brazilian Amazon

“…This figure is a minimum since HDV could not be amplified and genotyped from several of these patients. These data reinforce the important role of HBV/HDV coinfection (especially by the HDV‐3 genotype) on the severity of liver disease …”

“…These data reinforce the important role of HBV/HDV coinfection (especially by the HDV-3 genotype) on the severity of liver disease. [4][5][6][7][8] It has been postulated that there is a specific interaction of HDV-3/HBV-F genotypes possibly associated with fulminant hepatitis in Amazonian populations. 4,10,13 However, our data show that the HDV-3 genotype could be associated with the more prevalent HBV strains in a given population.…”

Age-standardized mortality rates related to viral hepatitis in Brazil

“…Data from the Ministry of Health (MoH) of Brazil estimated that 1.4–1.7 million people are chronically infected with hepatitis C virus (HCV) [ 7 ]. Presence of advanced fibrosis was reported in up to 30% of patients with hepatitis B and Delta coinfection in western Amazon Basin [ 8 , 9 ] and more than 800,000 liver-related hospitalizations (~30,000 admissions per year) were performed in the last decade in Brazil [ 10 ]. We previously reported a nationwide analysis describing an increase in number of deaths due to liver diseases and cirrhosis in the last decade [ 11 ].…”

Hepatitis delta virus infection in a large cohort of chronic hepatitis B patients in Ethiopia

“…However, a recent study by Couto et al gives some support to the use of Fibroscan in chronic HDV infection. Although it was not a validation study of Fibroscan vs biopsy, the authors reported a significant correlation between Fibroscan results and various measures of advancing liver fibrosis, such as splenic volume, bilirubin, platelet count, APRI and FIB‐4, in 77 HDV‐infected patients in Brazil …”

“…Of 1267 patients included in this study, 748 (59.0%) were men and the median age was 31 years (interquartile range [IQR] [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] by multiple logistic analysis, probably because of the small sample size available for the logistic model.…”