Hepatitis delta infection among persons living with HIV in Europe. Liver International
Béguelin et al. described the prevalence and clinical consequences of hepatitis delta (HDV) infection among individuals with HIV and hepatitis B virus (HBV) coinfection in Europe using data from the Swiss HIV Cohort Study and EuroSIDA.
All individuals with a positive HBsAg between 01/1988 and 12/2019 were considered, and if not already available from clinical specimens, HDV serology and HDV RNA were measured using stored samples. For prevalence estimates, HDV infection was defined as positive serology, and prevalence was calculated separately for the European regions (North-western Europe, Southern Europe, and Eastern Europe). Overall mortality, liver-related mortality, and incidence of hepatocellular carcinoma (HCC) were compared between individuals with HIV/HBV/HDV coinfection and those with HIV/HBV without HDV infection using multivariable Cox regression models.
Of 2’793 individuals with a positive HBs-Ag, 1’556 (56%) had results for HDV serology available. The prevalence of HDV coinfection overall was 15.2% (95% CI 13.5-17.1), and was similar across European regions. The highest prevalence was found among individuals who inject drugs, 50.5% being seropositive for HDV (95% CI 45.3-55.7). Compared to individuals with HIV/HBV coinfection, those with additional HDV coinfection were more likely to die from any cause (adjusted hazard ratio [aHR] 1.8, 95% CI 1.3-2.5) and from liver-related causes (aHR 3.1, 1.7-5.7), and were at higher risk for developing HCC (aHR 6.3, 2.5-16.0).
In summary, this large cohort collaboration found an overall prevalence of 15% of HDV infection among individuals with HIV/HBV coinfection, and of 50% among individuals who inject drugs. As individuals with additional HDV infection are at increased risk for morbidity and mortality, the present study underlines the importance of a systematic HDV screening of all individuals with HIV/HBV coinfection to provide HCC close clinical follow-up including screening for HCC.