Journal Article

Hepatitis Delta Is a Major Determinant of Liver Decompensation Events and Death in HIV-Infected Patients

Soriano, Vincent, Barreiro, Pablo, Fernández-Montero, José Vicente, Vispo, Eugenia, de Mendoza, Carmen, Sierra-Enguita, Rocío, Labarga, Pablo

2014

Overview

Background. Coinfection with hepatitis viruses is common in individuals infected with human immunodeficiency virus (HIV) and has become a leading cause of complications and death in those receiving antiretroviral therapy (ART). Methods. We retrospectively examined the effect of coinfection with hepatitis B, C, and/or D viruses (HBV, HCV, HDV, respectively) on liver decompensation events (ascites, variceal bleeding, encephalopathy, and/or hepatocellular carcinoma) and liver-related mortality in HIV-positive patients on regular follow-up since the year 2004 at a reference HIV clinic in Madrid, Spain. Results. A total of 1147 HIV-infected patients (mean age, 42 years; 81% males; 46% intravenous drug users, 85.4% on ART) were analyzed. Mean follow-up was 81.2 ± 17.8 months. At baseline, 521 patients (45.4%) were HCV-antibody positive, 85 (7.4%) were hepatitis B surface antigen positive, and 17 (1.5%) were anti-HDV positive. A total of 233 HIV/HCV-coinfected patients received antiviral therapy for HCV, of whom 106 (45%) achieved sustained virologic response (SVR). Overall, 15 patients died of liver-related complications and 26 developed hepatic decompensation events. Taking as controls the 524 HIV-monoinfected patients, HDV coinfection (adjusted hazard ratio [AHR], 7.5; 95% confidence interval [CI], 1.84–30.8; P= .005) and baseline liver stiffness (AHR, 1.1; 95% CI, 1.07–1.13; P < .0001) were associated with a higher rate of liver-related morbidity and mortality. In contrast, SVR following hepatitis C therapy in HIV/HCV-coinfected patients was protective (AHR, 0.11; 95% CI, .01–.86; P= .03). Conclusions. Hepatitis delta is associated with a high rate of death and liver decompensation events in HIV-infected patients on ART.

• Publisher: OXFORD UNIVERSITY PRESS,Oxford University Press
• Subject: Adult / Anti-Retroviral Agents - therapeutic use / Antiretroviral agents / Antiretroviral drugs / Antivirals / ARTICLES AND COMMENTARIES / Biological and medical sciences / Coinfection / Coinfection - complications / Coinfection - epidemiology / Drug therapy / Female / Hepacivirus / Hepatitis / Hepatitis antigens / Hepatitis B - complications / Hepatitis B - epidemiology / Hepatitis B virus / Hepatitis C - complications / Hepatitis C - epidemiology / Hepatitis D - complications / Hepatitis D - epidemiology / Hepatitis delta virus / HIV / HIV infections / HIV Infections - complications / HIV Infections - drug therapy / Human immunodeficiency virus / Human viral diseases / Humans / Immunodeficiencies / Immunodeficiencies. Immunoglobulinopathies / Immunopathology / Infectious diseases / Liver / Liver Failure - epidemiology / Liver Failure - mortality / Male / Medical sciences / Middle Aged / Mortality / Patients / Retrospective Studies / Spain - epidemiology / Survival Analysis / Viral diseases / Viral diseases of the lymphoid tissue and the blood. Aids / Viral hepatitis