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Hepatitis D virus (HDV) prevalence in Austria is low but causes considerable morbidity due to fast progression to cirrhosis
United European Gastroenterol J. 2021 Dec;9(10):1119-1127.doi: 10.1002/ueg2.12163. Epub 2021 Dec 7.
Mathias Jachs12, Teresa Binter12, Caroline Schmidbauer23, Lukas Hartl12, Michael Strasser4, Hermann Laferl5, Stephanie Hametner-Schreil6, Alexander Lindorfer6, Kristina Dax7, Rudolf E Stauber8, Harald H Kessler9, Sebastian Bernhofer10, Andreas Maieron10, Lorin Loacker11, Simona Bota12, Isabel Santonja13, Petra Munda1, Mattias Mandorfer12, Markus Peck-Radosavljevic12, Heidemarie Holzmann13, Michael Gschwantler23, Heinz Zoller14, Peter Ferenci1, Thomas Reiberger12
Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
HIV and Liver Disease Study Group, Medical University of Vienna, Vienna, Austria.
Division of Gastroenterology and Hepatology, Department of Medicine II, Klinik Ottakring, Vienna, Austria.
First Department of Medicine, Paracelsus Medical University, Salzburg, Austria.
Department of Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna, Austria.
Department of Gastroenterology and Hepatology, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria.
Department of Internal Medicine and Gastroenterology and Hepatology, Kepler Universitätsklinikum, Linz, Austria.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Institute for Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria.
Department of Internal Medicine II, University Hospital St. Pölten, St. Pölten, Austria.
Central Institute for Medical and Chemical Laboratory Diagnostics, Medical University of Innsbruck, Innsbruck, Austria.
Department of Internal Medicine and Gastroenterology, Hepatology, Endocrinology, Rheumatology and Nephrology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria.
Center for Virology, Medical University of Vienna, Vienna, Austria.
Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria.
Background: Hepatitis D virus (HDV) coinfection aggravates the course of hepatitis B virus (HBV). The prevalence of HDV in Austria is unknown.
Objective: This national study aimed at (i) recording the prevalence of HDV-infection in Austria and (ii) characterizing the "active" HDV cohort in Austria.
Methods: A total of 10 hepatitis treatment centers in Austria participated in this multicenter study and retrospectively collected their HDV patients between Q1/2010 and Q4/2020. Positive anti-HDV and/or HDV-RNA-polymerase chain reaction (PCR) results were retrieved from local database queries. Disease severity was assessed by individual chart review. Viremic HDV patients with clinical visits in/after Q1/2019 were considered as the "active" HDV cohort.
Results: A total of 347 anti-HDV positive patients were identified. In 202 (58.2%) patients, HDV-RNA-PCR test was performed, and 126/202 (62.4%) had confirmed viremia. Hepatocellular carcinoma was diagnosed in 7 (5.6%) patients, 7 (5.6%) patients underwent liver transplantation, and 11 (8.7%) patients died during follow-up. The "active" Austrian HDV cohort included 74 (58.7%) patients: Evidence for advanced chronic liver disease (ACLD, i.e., histological F3/F4 fibrosis, liver stiffness ≥10 kPa, varices, or hepatic venous pressure gradient ≥6 mmHg) was detected in 38 (51.4%) patients, including 2 (5.3%) with decompensation (ascites/hepatic encephalopathy). About 37 (50.0%) patients of the "active" HDV cohort had previously received interferon treatment. Treatment with the sodium-taurocholate cotransporting polypeptide inhibitor bulevirtide was initiated in 20 (27.0%) patients.
Conclusion: The number of confirmed HDV viremic cases in Austria is low (<1% of HBV patients) but potentially underestimated. Testing all HBV patients will increase the diagnostic yield. More than half of viremic HDV patients had ACLD. Improved HDV testing and workup strategies will facilitate access to novel antiviral therapies.