People with HBV, HIV coinfection at risk for hepatitis D ‘superinfection’
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Key takeaways:
- Patients with HIV and hepatitis B coinfection are at an increased risk for hepatitis D.
- Patients with hepatitis D have an increased risk for liver-related complications and mortality.
Patients with HIV and hepatitis B coinfection are at an increased risk for hepatitis D, which is associated with an increased risk of liver-related complications and mortality, researchers found.
“Two main factors prompted this study,” Yu-Shan Huang, MD, physician at National Taiwan University Hospital, told Healio. “First, hepatitis D virus has often been neglected in hepatitis B virus (HBV)-infected patients, with limited data on hepatitis D virus epidemiology in HBV/HIV coinfected patients in Asian countries. Second, the epidemiology of HBV among people with HIV (PWH) in Taiwan has evolved, and the introduction of tenofovir has reduced HBV's adverse impact on HIV patients.”
“Therefore, we reevaluated the incidence and outcomes of hepatitis D virus infection among PWH in Taiwan,” Huang said.
The researchers conducted a retrospective study assessing patients aged 20 years and older with HIV and hepatitis B coinfection who sought HIV care at the National Taiwan University Hospital between 2011 and 2022.
The patients were followed from their first visit after 2011 until either loss to follow-up, transfer to another hospital, death or the end of the study on Dec. 31, 2023. According to the study, the researchers then estimated the hepatitis D seroprevalence and incidence of hepatitis D seroconversion. They also analyzed survival and liver-related outcomes between patients with and without hepatitis D.
In total, 534 people with HIV and HBV coinfection were included in the study. Of them, 36 (6.7%) tested hepatitis D-seropositive at baseline. During the 3,987.78 person-years of follow-up observed in the study, 50 (10%) additional PWH seroconverted for hepatitis D virus, with an overall incidence rate of 12.54 per 1,000 person-years of follow-up.
After comparing PWH with and without hepatitis D infection, the researchers found that hepatitis D infection remained associated with an increased risk of liver-related death, despite most patients receiving tenofovir-containing ART.
Specifically, data showed that the patients with hepatitis D had significantly higher rates of liver-related mortality (3.5% vs. 0.4%; P = .032), cirrhosis (11.3% vs. 3.6%, P = .008) and hepatitis flare (28.2% vs. 14.2%; P = .001).
Based on these findings, Huange concluded that PWH and HBV coinfection remain at risk for hepatitis D virus “superinfection” in the era of tenofovir-containing ART. He added that regular monitoring of hepatitis D virus serostatus in at-risk PWH is crucial for timely linkage to prevention and care.
Although the study assessed patients in Taiwan, Huang said there is still a key clinical takeaway for U.S. clinicians.
“For PWH with HBV who are at risk for hepatitis D virus infection (eg, people who inject drugs or are sexually active), ongoing monitoring of hepatitis D virus serostatus should be considered,” she said. “Those with hepatitis D virus infection require careful monitoring for liver-related complications.”
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