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HDV coinfection increased cirrhosis risk among HBV patients

Patients with hepatitis B are at greater risk for developing cirrhosis when coinfected with hepatitis delta, according to recent results.

Researchers performed a retrospective chart review of 1,191 patients with chronic hepatitis B observed at a medical center in California. Incidence of hepatitis delta (HDV) and/or HCV coinfection was observed, and information on HDV viral load and presentation were collected.

Testing for HDV was performed in 499 cases, with 42 cases of coinfection observed. Infection with HBV, HDV and HCV occurred in 21 patients (tri-infected). HDV-infected patients had a median age of 47 years and most often were Caucasian (69%) or Asian and Pacific Islanders (24%).

Among 41 evaluable participants, cirrhosis was more common in coinfected patients (73% of cases) compared with those with HBV alone (22%; P<.0001). Tri-infected patients with evaluable cirrhosis data also were significantly more likely to be cirrhotic (80% of cases; P<.0001). More than half of patients with evaluable HBV DNA levels at HDV presentation had undetectable HBV (56%), while levels greater than 100,000 IU/mL were observed in four cases.

The investigators cited the study’s retrospective nature and lack of HDV data for the majority of the cohort as notable limitations. Still, they wrote that the results suggested the need to revise HBV screening guidelines to address HDV coinfection.

“We believe that the substantially increased risk of cirrhosis we observed in the HDV-infected combined with the relatively low cost of screening for the anti-HDV antibody support a recommendation to guidelines committees to consider advocating for all patients with HBV to be screened for HDV coinfection, and as an absolute minimum all those who have advanced liver disease or are members of high-risk groups,” the researchers wrote. “Screening all patients who are [hepatitis B surface antigen]-positive for HDV could result in earlier diagnosis and possible treatment intervention.”