‘Only one in six’ veterans with chronic HBV finish HDV testing despite severe disease risk
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Key takeaways:
- Less than 20% of veterans with chronic HBV completed testing for HDV.
- Veterans with chronic HBV who were HDV positive had a higher risk for progressing to cirrhosis and hepatic decompensation.
Among veterans with chronic hepatitis B virus infection, rates of hepatitis D virus testing were low and those with concurrent infection were at greater risk for cirrhosis and hepatic decompensation, according to study results.
“HDV in the setting of chronic HBV infection is associated with more rapid disease progression and higher risks of cirrhosis, liver cancer and death,” Robert J. Wong, MD, MS, of the divisions of gastroenterology and hepatology at Stanford University School of Medicine and VA Palo Alto Health Care, told Healio. “However, there is overall lack of awareness of HDV and existing studies report low rates of HDV testing.”
He continued, “The aim of this study was to evaluate HDV testing patterns and outcomes among a national cohort of veterans with chronic HBV. Data from this study will help raise greater awareness of the burden of HDV in veterans as well as the general population.”
Using the 2010-’23 VA Corporate Data Warehouse, Wong and colleagues identified 27,548 patients (93.2% men; mean age, 57.6 years) with chronic HBV, of whom 24.6% were hepatitis B e antigen-positive, 22.5% had concurrent hepatitis C virus infection and 2.8% also had HIV. In addition, 10.5% of patients presented with cirrhosis and 1% with hepatocellular carcinoma at the time of HBV diagnosis.
According to data published in Gastro Hep Advances, 16.1% (n = 4,437) of the cohort completed testing for HDV — “only one in six,” Wong noted — and 3.25% (n = 144) were HDV positive.
Results also showed odds of completing HDV testing were significantly higher among patients who were HBeAg-positive (OR = 1.16; 95% CI, 1.04-1.28), on HBV antiviral therapy (OR = 1.79; 95% CI, 1.65-1.94), had HIV (OR = 1.32; 95% CI, 1.07-1.64) and among men (OR = 1.24; 95% CI, 1.07-1.43), as well as among Asian and Pacific Islanders (OR = 1.49; 95% CI, 1.32-1.68) and African Americans (OR = 1.08; 95% CI, 1-1.17). Odds of testing were lower among patients with concurrent HCV (OR = 0.73; 95% CI, 0.64-0.83).
Of patients who tested positive for HDV, a higher proportion were HBeAg-negative (3.6% vs. 2.9%; P < .05), HCV-positive (8.5% vs. 2.4%, P < .001) and had cirrhosis (7.7% vs. 2.8%; P < .001).
To compare the incidence of liver-related outcomes among HDV-positive vs. negative patients, Wong and colleagues propensity-score matched 71 patients with HDV to 140 patients without HDV, after excluding those with baseline cirrhosis or HCC. The median follow-up was 5.3 years and 4.5 years, respectively, for each group.
According to results, patients who were HDV-positive had a significantly higher incidence of cirrhosis (4.39 vs. 1.3 per 100,000 person-years; P < .01) and hepatic decompensation (2.18 vs. 0.41 per 100,000 person-years; P < .05) compared with those who were HDV-negative. The incidence of HCC was also higher among HDV-positive patients, although it did not reach statistical significance (1.28 vs. 0.41 per 100,000 person-years).
“Patients who were positive for HDV infection had significant greater risk of progression to cirrhosis and hepatic decompensation, emphasizing that HDV infection in patients with known chronic HBV have more severe disease,” Wong told Healio.
He added, “These data aim to raise awareness of the importance of HDV testing among the chronic HBV population. Early testing followed by linkage to care and treatment can help mitigate the morbidity and mortality associated with HDV infection.”
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