Hepatitis D co-infection linked with worse outcomes, higher mortality in hepatitis B
Patients with both hepatitis D and hepatitis B are more than twice as likely to develop hepatocellular carcinoma and decompensation and to die of liver-related causes than those with hepatitis B virus alone, according to a study of Veterans Health Administration data.
Co-infection with hepatitis D virus (HDV) and hepatitis B virus (HBV) is associated with an increased risk of poor liver-related outcomes and all-cause mortality, a cohort analysis found.
Researchers assessed data from 4,817 veterans with HBV who were tested for HDV between 2000 and 2022. Median patient age was 56.9 years, 95% were male, and 57.4% had a history of substance use disorders. A total of 158 (3.3%) were HDV positive. HDV-positive patients were more likely to have a history of substance use disorder, elevated alanine aminotransferase levels, and cirrhosis. Liver transplantation was also more common in patients with HDV, though less than 1% of all patients in the study underwent the procedure. Primary outcomes included a composite score of hepatocellular carcinoma (HCC), decompensation, liver-related mortality, and all-cause mortality. Findings were published by Hepatology on Sept. 10.
HDV co-infection was linked with a significantly higher composite score of liver-related outcomes versus HBV only, at both five- (23.84 vs. 7.98; P<0.001) and 10-year follow-up (19.14 vs. 10.18; P<0.001), respectively. The most common cause of death among all patients was liver-related (33.8% for HDV vs. 24.7% for HBV); the second leading cause of death was nonhepatic malignancies (15.6% vs. 14.8%), followed by cardiac causes (11.7% vs. 15.2%) and lung disease (5.2% vs. 3.7%).
HDV co-infection had the greatest effect on the outcome of HCC (adjusted hazard ratio [aHR], 3.70), followed by hepatic decompensation (aHR, 2.08), liver-related mortality (aHR, 1.91), and all-cause mortality (aHR, 1.55). After adjustment for age, body mass index, substance use disorder, and other factors, HDV was still associated with an increased risk of composite liver outcomes (aHR, 2.57 [95% CI, 1.87 to 3.52]; P<0.001) and all-cause mortality (aHR, 1.52 [95% CI, 1.20 to 1.93]; P<0.001). Being male and underweight were both associated with an increased risk of all-cause mortality (aHRs, 2.04 [95% CI, 1.37 to 3.03] and 2.31 [95% CI, 1.72 to 3.11], respectively; P<0.001 for both).
The findings may not be generalizable to women and nonveterans, the study authors cautioned. “With the impending arrival of novel antivirals, these findings highlight the need for more widespread HDV testing so that patients with HDV can be identified for treatment,” they concluded.