Akıllı Fatih Mehmet, Özbay Haliloğlu Elif Nur, Güncü Mehmet Mücahit, Turan Gökçe Dilara
Department of Microbiology, Sincan Training and Research Hospital, Ankara 06930, Türkiye.
Department of Infectious Diseases and Clinical Microbiology, Sincan Training and Research Hospital, Ankara 06930, Türkiye.
Viruses. 2025 Apr 15;17(4):568. doi: 10.3390/v17040568.
This study aimed to assess the prevalence of HDV (hepatitis delta virus), HCV (hepatitis C virus), and HIV (human immunodeficiency virus) coinfections among HBsAg-positive patients and to determine the severity of liver fibrosis and biochemical markers. Furthermore, the study sought to evaluate the noninvasive fibrosis scores (APRI and FIB4) in predicting the severity of liver disease in patients with hepatitis B. A retrospective analysis of 1434 patients with chronic HBV admitted between January 2020 and December 2024 was conducted at Sincan Tertiary Hospital. The positivity rates of the following antibodies were the focus of the study: anti-HDV, anti-HCV, and anti-HIV. In addition to these, the levels of HIV-RNA, HCV-RNA and HBV-DNA, as well as several biochemical markers (ALT, AST, INR, albumin, bilirubin and platelet count) were also evaluated. The APRI and FIB-4 scores were calculated. Of the 1434 patients, 49 (3.4%) tested positive for anti-HDV, 784 were screened for anti-HCV, and 749 were screened for anti-HIV. The positivity rates were 3.4% (27/784) and 3.4% (26/749), respectively. According to ROC analysis, the FIB-4 score had a statistically significant effect on predicting anti-HDV negativity (AUC = 0.59, = 0.031). However, the APRI score was not a significant predictor for anti-HDV positivity (AUC = 0.53, > 0.05). APRI and FIB-4 scores did not have a statistically significant discriminatory power in predicting anti-HCV and anti-HIV positivity ( > 0.05). The cut-off value for the FIB-4 score in predicting anti-HDV positivity was 1.72, with a sensitivity of 61.4% and a specificity of 42.9% ( = 0.031). Among the HCV/RNA-positive patients (n = 5), all were male, and two also had positive anti-HBe results with undetectable HBV/DNA levels. One HIV/RNA-positive patient, a foreign national, was confirmed to have HIV/HBV/HDV infection. All HBsAg-positive patients should undergo routine anti-HDV testing. Vaccination programmes are vital in preventing the spread of HDV. Dual screening strategies are essential for identifying infected individuals and developing prevention and treatment programmes. Anti-HDV positivity indicates advanced liver fibrosis, emphasising the importance of screening and monitoring. However, the limited accuracy of the APRI and FIB-4 scores for detecting coinfections highlights the need to integrate noninvasive methods with molecular diagnostics for precise management.
本研究旨在评估HBsAg阳性患者中丁型肝炎病毒（HDV）、丙型肝炎病毒（HCV）和人类免疫缺陷病毒（HIV）合并感染的患病率，并确定肝纤维化的严重程度和生化标志物。此外，该研究还试图评估无创纤维化评分（APRI和FIB4）在预测乙型肝炎患者肝病严重程度方面的作用。于2020年1月至2024年12月期间在辛坎三级医院对1434例慢性HBV患者进行了回顾性分析。本研究重点关注以下抗体的阳性率：抗HDV、抗HCV和抗HIV。除此之外，还评估了HIV-RNA、HCV-RNA和HBV-DNA水平，以及几种生化标志物（谷丙转氨酶、谷草转氨酶、国际标准化比值、白蛋白、胆红素和血小板计数）。计算了APRI和FIB-4评分。在1434例患者中，49例（3.4%）抗HDV检测呈阳性，784例接受了抗HCV筛查，749例接受了抗HIV筛查。阳性率分别为3.4%（27/784）和3.4%（26/749）。根据ROC分析，FIB-4评分在预测抗HDV阴性方面具有统计学显著效果（曲线下面积=0.59，P=0.031）。然而，APRI评分并非抗HDV阳性的显著预测指标（曲线下面积=0.53，P>0.05）。APRI和FIB-4评分在预测抗HCV和抗HIV阳性方面没有统计学显著的鉴别能力（P>0.05）。预测抗HDV阳性的FIB-4评分临界值为1.72，敏感性为61.4%，特异性为42.9%（P=0.031）。在HCV/RNA阳性患者（n=5）中，均为男性，其中2例抗HBe结果也为阳性，HBV/DNA水平检测不到。1例HIV/RNA阳性患者为外国公民，确诊为HIV/HBV/HDV感染。所有HBsAg阳性患者均应接受常规抗HDV检测。疫苗接种计划对于预防HDV传播至关重要。双重筛查策略对于识别感染个体以及制定预防和治疗计划至关重要。抗HDV阳性表明肝纤维化进展，强调了筛查和监测的重要性。然而，APRI和FIB-4评分检测合并感染的准确性有限，这凸显了将无创方法与分子诊断相结合以进行精准管理的必要性。
