Infectious and Tropical Diseases, Padua University Hospital, Padua, Italy.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Pathog Glob Health. 2023 Mar;117(2):181-189. doi: 10.1080/20477724.2022.2047551. Epub 2022 Mar 7.
Hepatitis Delta virus (HDV) causes severe liver disease. Due to similarities in transmission routes, persons living with HIV (PLWH) are at risk of HDV infection. This analysis investigates the prevalence and the long-term clinical outcome of people with HDV in a large cohort of PLWH. We retrieved HBsAg ± anti-HDV positive PLWH enrolled from 1997 to 2015 in the multicentre, prospective ICONA study. The primary endpoint was a composite clinical outcome (CCO = having experienced ≥1 of the following: Fib4 score >3.25; diagnosis of cirrhosis; decompensation; hepatocellular carcinoma or liver-related death). Kaplan-Meier curves and unweighted and weighted Cox regression models were used for data analysis. Less than half of HBsAg positive patients had been tested for anti-HDV in clinical practice. After testing stored sera, among 617 HBV/HIV cases, 115 (19%) were anti-HDV positive; 405 (65%) HBV monoinfected; 99 (16%) undeterminate. The prevalence declined over the observation period. HDV patients were more often males, intravenous drug users, HCV coinfected. After a median of 26 months, 55/115 (48%) developed CCO among HDV+; 98/403 (24%) among HBV monoinfected; 18/99 (18%) in HDV unknown (p < 0.001). After controlling for geographical region, alcohol consumption, CD4 count, anti-HCV status and IFN-based therapies, the association with HDV retained statistical significance [HR = 1.67 (1.15, 2.95; p = 0.025)]. HDV infection among PLWH is underdiagnosed, although HDV entails an high risk of liver disease progression. Because effective drugs to treat HDV are now available, it is even more crucial to identify PLWH at an early stage of liver disease.
丁型肝炎病毒（HDV）可导致严重的肝脏疾病。由于传播途径相似，感染人类免疫缺陷病毒（HIV）的人（PLWH）有感染 HDV 的风险。本分析调查了在 ICONA 多中心前瞻性研究中，大型 PLWH 队列中 HDV 感染者的流行率和长期临床结局。我们检索了 1997 年至 2015 年间 HBsAg ± 抗-HDV 阳性的 PLWH 患者。主要终点是复合临床结局（CCO=经历以下至少一项：Fib4 评分>3.25；肝硬化诊断；失代偿；肝细胞癌或与肝脏相关的死亡）。使用 Kaplan-Meier 曲线和未加权和加权 Cox 回归模型进行数据分析。在临床实践中，不到一半的 HBsAg 阳性患者接受过抗-HDV 检测。在检测储存的血清后，在 617 例 HBV/HIV 病例中，115 例（19%）抗-HDV 阳性；405 例（65%）HBV 单感染；99 例（16%）未确定。在观察期间，HDV 的流行率下降。HDV 患者中男性、静脉吸毒者、HCV 合并感染的比例更高。在中位数为 26 个月后，115 例 HDV+患者中有 55 例（48%）发生 CCO；403 例 HBV 单感染患者中有 98 例（24%）；99 例 HDV 未知患者中有 18 例（18%）（p<0.001）。在控制地理区域、饮酒、CD4 计数、抗 HCV 状态和 IFN 为基础的治疗后，与 HDV 的关联仍具有统计学意义[风险比（HR）=1.67（1.15，2.95；p=0.025）]。尽管有效的治疗 HDV 的药物现在已经可用，但在疾病早期识别 PLWH 更为重要。PLWH 中 HDV 的诊断不足，尽管 HDV 导致肝脏疾病进展的风险很高。
