Liver Unit, IRCCS Fondazione "Casa Sollievo della Sofferenza", 71013 San Giovanni Rotondo, Italy.
Blood Bank, IRCCS Fondazione "Casa Sollievo della Sofferenza", 71013 San Giovanni Rotondo, Italy.
Cells. 2023 May 17;12(10):1413. doi: 10.3390/cells12101413.
Identification of outcome predictors is one of the unmet needs in chronic HDV infection. Until recently, no reliable quantitative assays for HDV RNA were available.
To evaluate the impact of baseline viremia on natural history of HDV infection in a cohort of patients whose serum samples were stored at their first visit 15 years ago.
Quantitative HBsAg, HBeAg, HBeAb, HBV DNA, HDV RNA, genotypes, and liver disease severity were assessed at baseline. Patients who were no longer on active follow-up were recalled and re-evaluated in August 2022.
The majority of patients were male (64.9%); the median age was 50.1 years; and all patients were Italian, with only three born in Romania. All were HBeAg negative with HBV genotype D infection. Patients were subdivided three groups: 23 were in active follow-up (Group 1), 21 were recalled due to no longer being in follow-up (Group 2), and 11 died (Group 3). Liver cirrhosis was diagnosed in 28 subjects at the first visit; 39.3% of diagnosed patients were in Group 3, 32.1% were in Group 1 and 28.6% were in Group 2 ( = 0.001). Baseline HBV DNA IU/mL Log10 were 1.6 (1.0-5.9) in Group 1, 1.3 (1.0-4.5) in Group 2, and 4.1 (1.5-4.5) in Group 3; median baseline HDV RNA Log10 levels were 4.1 (0.7-6.7) in Group 1, 3.2 (0.7-6.2) in Group 2, and 5.2 (0.7-6.7) in Group 3, resulting significantly higher rates among patients in Group 3 compared to the other groups ( = 0.038). Eighteen patients in Group 2, as compared to 7 in Group 1, had undetectable HDV RNA at the follow-up evaluation ( = 0.001).
HDV chronic infection is a heterogeneous disease. It may not only progress but also improve over time in patients, who eventually become HDV RNA-undetectable. HDV RNA levels may help identify the subgroup of patients with less progressive liver disease.
鉴定结局预测因子是慢性 HDV 感染的未满足需求之一。直到最近，还没有可靠的 HDV RNA 定量检测方法。
评估基线病毒血症对 15 年前首次就诊时储存血清样本的患者的 HDV 感染自然史的影响。
在基线时评估定量 HBsAg、HBeAg、HBeAb、HBV DNA、HDV RNA、基因型和肝病严重程度。召回不再进行主动随访的患者，并于 2022 年 8 月重新评估。
大多数患者为男性（64.9%）；中位年龄为 50.1 岁；所有患者均为意大利人，仅有 3 人出生于罗马尼亚。所有患者均为 HBeAg 阴性，HBV 基因型为 D。患者分为三组：23 例在进行主动随访（第 1 组），21 例因不再随访而被召回（第 2 组），11 例死亡（第 3 组）。首次就诊时诊断为肝硬化的患者有 28 例；诊断为肝硬化的患者中，39.3%为第 3 组，32.1%为第 1 组，28.6%为第 2 组（ = 0.001）。第 1 组的基线 HBV DNA IU/mL Log10 为 1.6（1.0-5.9），第 2 组为 1.3（1.0-4.5），第 3 组为 4.1（1.5-4.5）；第 1 组的基线 HDV RNA Log10 中位数为 4.1（0.7-6.7），第 2 组为 3.2（0.7-6.2），第 3 组为 5.2（0.7-6.7），第 3 组的 HDV RNA 水平明显高于其他两组（ = 0.038）。与第 1 组的 7 例相比，第 2 组的 18 例患者在随访评估时 HDV RNA 不可检测（ = 0.001）。
HDV 慢性感染是一种异质性疾病。患者的 HDV RNA 可能不仅会进展，而且随着时间的推移会改善，最终 HDV RNA 不可检测。HDV RNA 水平可能有助于鉴定出肝病进展较慢的患者亚组。
