(O5) A long-term study of 337 hepatitis D virus (HDV) and hepatitis B virus co-infected patients: the impact of HDV viremia on liver-related outcomes
Habiba Kamal, Gabriel Westman, Karolin Falconer, Ann-Sofi Duberg, Ola Weiland, Susanna Haverinen, Rune Wejstål, Tony Carlsson, Christian Kampmann, Simon Larsson, Per Björkman, Anders Nystedt, Kristina Cardell, Stefan Svensson, Stephan Stenmark, Heiner Wedemeyer, Soo Aleman.
Habiba Kamal[1, 2], Gabriel Westman, Karolin Falconer[1, 2], Ann-Sofi Duberg, Ola Weiland[1, 2], Susanna Haverinen, Rune Wejstål, Tony Carlsson, Christian Kampmann, Simon Larsson, Per Björkman, Anders Nystedt, Kristina Cardell, Stefan Svensson, Stephan Stenmark, Heiner Wedemeyer, Soo Aleman[1, 2]. . Department of Infectious Diseases, Karolinska University Hospital, Sweden. . Department of Medicine Huddinge, Karolinska Institutet, Sweden. . Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden. . Department of Infectious Diseases, Örebro University Hospital, Sweden. . Department of Infectious Diseases, Sahlgrenska University Hospital, Sweden. . Department of Infectious Diseases, Danderyd University Hospital, Sweden. . Department of Infectious Diseases, Skåne University Hospital Lund, Sweden. . Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden . Department of Infectious Diseases, Skåne University Hospital Malmö, Sweden. . Department of Infectious Diseases, Sunderby Hospital, Sweden. . Department of Infectious Diseases and Department of Clinical and Experimental Medicine, Linköping University, Sweden. .Department of Infectious Diseases, University Hospital of Umeå, Sweden. .Department of Gastroenterology and Hepatology, University of Essen.
Background & Aims: The impact of hepatitis D virus (HDV) viremia on liver-related outcomes has not been previously fully investigated outside HIV co-infection setting. The long-term risks for liver-related events of anti-HDV positive patients with hepatitis B virus (HBV) infection were therefore studied according to HDV RNA status, cirrhosis and age, and the impact of virological response to interferon alpha (IFNα)-based therapies was assessed.
Methods: A Swedish cohort of 337 anti-HDV positive patients attending secondary care centers, including 233 patients with HDV RNA viremia at baseline, was retrospectively studied. The risk for liver-related events (i.e., hepatocellular carcinoma, hepatic decompensation, or liver-related death/transplantation) or individual events was assessed, using Cox regression analysis.
Results: A significantly increased risk of liver-related events could be seen in patients with HDV RNA viremia (Hazard ratio [HR] =3.82, 95% confidence interval [CI] 1.48–9.82), cirrhosis (HR=10.26, 95% CI 5.47–19.23) and older age (HR=1.05, 95% CI 1.03–1.08) at baseline. However, 80.6 % of non-cirrhotic patients with HDV RNA viremia at baseline did not develop liver-related events after 15 years of follow-up. Among 101 IFN-treated HDV RNA positive patients, 18.8% were HDV RNA undetectable 24–48 weeks post-treatment, but late relapse occurred in 26.3%. The risk for liver-related outcomes was higher in virological non-responders compared to responders, but without statistical significance.
Conclusion: HDV RNA viremia is associated with a 3.8 fold increased risk for liver-related outcomes. Nevertheless, a majority of non-cirrhotic viremic patients had a more benign course in their liver disease, than previously estimated in studies from mainly tertiary health care. Poor response to current antiviral therapy highlights, however, the need for better HDV treatment options.