Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland.
Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland.
J Hepatol. 2017 Feb;66(2):297-303. doi: 10.1016/j.jhep.2016.10.007. Epub 2016 Oct 14.
BACKGROUND & AIMS: Hepatitis delta virus (HDV) infection accelerates the progression of hepatitis B virus (HBV)-related liver disease. We assessed the epidemiological characteristics of HDV infection in the nationwide Swiss HIV Cohort Study and evaluated its impact on clinical outcomes.
All HIV-infected patients with a positive hepatitis B surface antigen test were considered and tested for anti-HDV antibodies. HDV amplification and sequencing were performed in anti-HDV-positive patients. Demographic and clinical characteristics at initiation of antiretroviral therapy, as well as causes of death were compared between HDV-positive and HDV-negative individuals using descriptive statistics. Kaplan-Meier and multivariable Cox regression analyses were used to evaluate the association between HDV infection and overall mortality, liver-related mortality as well as incidence of hepatocellular carcinoma (HCC).
Of 818 patients with a positive hepatitis B surface antigen tests, 771 (94%) had a stored serum sample available and were included. The prevalence of HDV infection was 15.4% (119/771, 95% CI: 12.9-18.0) and the proportion of HDV-positive patients with HDV replication 62.9% (73/116). HDV-infected patients were more likely to be persons who inject drugs (60.6% vs. 9.1%) and to have a positive hepatitis C virus (HCV) serology (73.1% vs. 17.8%) compared to HDV-uninfected ones. HDV infection was strongly associated with overall death (adjusted hazard ratio 2.33, 95% CI 1.41-3.84), liver-related death (7.71, 3.13-18.97) and with the occurrence of HCC (9.30, 3.03-28.61). Results were similar when persons who inject drugs or HCV-coinfected patients were excluded from the analyses.
The prevalence of HDV in hepatitis B surface antigen-positive patients in the Swiss HIV Cohort Study (SHCS) is high and HDV infection is independently associated with mortality and liver-related events, including HCC.
Hepatitis delta virus (HDV) infection accelerates the progression of hepatitis B virus (HBV)-related liver disease. In a nationwide cohort of HIV-infected individuals in Switzerland, 15% of HBV-coinfected patients had antibodies to HDV infection, of which a majority had active HDV replication. HDV-infected individuals were 2.5 times more likely to die, eight times more likely to die from a liver-related cause and nine times more likely to develop liver cancer compared to HDV-uninfected ones. Our results emphasize the need for prevention programs (including HBV vaccination), the systematic screening of at risk populations as well as close monitoring, and underline the importance of developing new treatments for chronic HDV infection.
乙型肝炎病毒（HBV）相关肝病的进展会受到乙型肝炎病毒（HDV）感染的影响。我们评估了全国性瑞士艾滋病毒队列研究（Swiss HIV Cohort Study，SHCS）中 HDV 感染的流行病学特征，并评估了其对临床结局的影响。
所有 HBsAg 阳性的 HIV 感染者均被考虑进行抗-HDV 抗体检测。在抗-HDV 阳性患者中进行 HDV 扩增和测序。采用描述性统计方法比较 HDV 阳性和 HDV 阴性个体在开始抗逆转录病毒治疗时的人口统计学和临床特征，以及死亡原因。采用 Kaplan-Meier 法和多变量 Cox 回归分析评估 HDV 感染与全因死亡率、肝脏相关死亡率以及肝细胞癌（HCC）发生率之间的关系。
在 818 例 HBsAg 阳性的患者中，771 例（94%）有存储的血清样本可供使用并被纳入分析。HDV 感染的患病率为 15.4%（119/771，95%CI：12.9-18.0），有 HDV 复制的 HDV 阳性患者比例为 62.9%（73/116）。与 HDV 阴性患者相比，HDV 感染患者更可能是注射毒品者（60.6% vs. 9.1%），并且更可能具有 HCV 血清学阳性（73.1% vs. 17.8%）。HDV 感染与全因死亡（调整后的危险比 2.33，95%CI 1.41-3.84）、肝脏相关死亡（7.71，3.13-18.97）和 HCC 发生（9.30，3.03-28.61）密切相关。当排除吸毒者或 HCV 合并感染患者后，结果仍然相似。
在瑞士艾滋病毒队列研究（SHCS）中，HBsAg 阳性患者中 HDV 的流行率较高，HDV 感染与死亡率和肝脏相关事件（包括 HCC）独立相关。
乙型肝炎病毒（HBV）相关肝病的进展会受到乙型肝炎病毒（HDV）感染的影响。在瑞士的一项全国性 HIV 感染者队列研究中，15%的 HBV 合并感染者有抗 HDV 抗体，其中大多数有活跃的 HDV 复制。与 HDV 阴性患者相比，HDV 感染患者死亡风险增加 2.5 倍，死于肝脏相关原因的风险增加 8 倍，发生肝癌的风险增加 9 倍。我们的研究结果强调了需要制定预防计划（包括 HBV 疫苗接种）、对高危人群进行系统筛查和密切监测，并强调了开发新型慢性 HDV 感染治疗方法的重要性。
