Hepatitis delta-associated mortality in HIV/HBV-coinfected patients. Journal of Hepatology
Béguelin et al. aimed to describe the main epidemiological characteristics of hepatitis delta virus (HDV) infection and to evaluate its impact on clinical outcomes in the Swiss HIV Cohort Study. The prevalence of HDV infection was 15.4% (119/771) and the proportion of HDV-positive patients with HDV replication 62.9% (73/116).
HDV-positive individuals were more likely to be people who inject drugs (60.6% vs. 9.1%) and to have a positive hepatitis C virus serology (73.1% vs. 17.8%). Of note, in HIV/HBV/HDV-coinfected patients with replicating HDV, HCV RNA was suppressed in 90% of patients.
In multivariable analyses, HDV infection was strongly associated with overall death (adjusted hazard ratio [aHR] 2.33), with liver-related mortality (aHR 7.71), and with the occurrence of hepatocellular carcinoma (aHR 9.30). In addition, HDV replication was strongly associated with overall death (aHR 7.14), liver-related mortality and the occurrence of hepatocellular carcinoma. In analyses restricted to patients who had received tenofovir (77%), the point estimate of the association between HDV infection and overall death remained similar.
In conclusion, there is a high prevalence of hepatitis delta in HIV/HBV-coinfected individuals in Switzerland. The strong association between HDV infection and mortality as well as liver-related events, including hepatocellular carcinoma, highlights the importance of HDV screening of all HIV/HBV-coinfected patients.