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Abstract Details
Determinants of worse liver-related outcome according to HDV infection among HBsAg positive persons living with HIV: Data from the ICONA cohort
Liver Int. 2023 Dec 15. doi: 10.1111/liv.15804. Online ahead of print.
2Department of Biology, University of Rome Tor Vergata, Rome, Italy.
3Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.
4Unity of Microbiology and Biobank, INMI, Rome, Italy.
5Department of Medicine of Systems, University of Rome Tor Vergata, Rome, Italy.
6Clinical and Research Infectious Diseases Department, INMI, Rome, Italy.
7Infectious Diseases, Department of Molecular Medicine, University of Padua, Padua, Italy.
8Department of Health Sciences, ASST Santi Paolo e Carlo, Clinic of Infectious Diseases, University of Milan, Milan, Italy.
9Department of Medical and Surgical Sciences, Alma Mater Studiorum Bologna University, Bologna, Italy.
10Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, Niguarda Ca' Granda Hospital, Milan, Italy.
11Clinic of Infectious Diseases, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy.
12Clinic of Infectious Diseases, University of Foggia, Foggia, Italy.
13University L. Vanvitelli, Infectious Diseases Unit, Naples, Italy.
Abstract
Objectives: We aimed to study hepatitis D virus (HDV) prevalence and risk of progression to severe liver-related events (SLRE) in HBsAg positive people living with HIV (PLWH) in Italy; role of HDV-RNA copy levels, HCV coinfection and nadir CD4 counts were also investigated.
Methods: People living with HIV (PLWH) from Italian Foundation cohort Naïve antiretrovirals (ICONA) with available HBsAg and HDV Ab were enrolled. HBsAg, HDV Ab, HDV-RNA and HDV genotypes were tested.
Primary end-point: time from first HDV screening to Severe Liver Related Events (SLRE: decompensated cirrhosis, liver transplantation, HCC). Fine-grey regression models were used to evaluate the association of HDV Ab, HDV-RNA, HDV/HCV coinfection, CD4 nadir and outcome. Secondary end-points: time to SLRE or death; HDV Ab and HDV-RNA prevalence.
Results: A total of 152/809 (18.8%) HBsAg positive PLWH showed HDV Ab reactivity; 63/93 (67.7%) were HDV-RNA positive. Being male, persons who inject drugs (PWID), HCV Ab positive, with FIB-4 > 3.25 were independent factors of HDV Ab positivity. In a median follow-up of 5 years, 37 PLWH (4.1% at 5-year) developed SLRE and 97 (12.0%) reached the SLRE or death end-point. HDV-RNA positive (independently from HDV-RNA copy level) PLWH had a 4.6-fold (95%CI 2.0-10.5) higher risk of SLRE than HDV negatives. PLWH positive for both HCV Ab and HDV Ab showed the highest independent risk of SLRE (ASHR: 11.9, 95%CI: 4.6-30.9 vs. HCV neg/HDV neg). Nadir CD4 < 200/mL was associated with SLRE (ASHR: 3.9, 95% 1.0-14.5).
Conclusions: One-fifth of the HBsAg positive PLWH harbour HDV infection, and are at high risk of progression to advanced liver disease. HCV contributes to worse outcomes. This population needs urgently effective treatments.
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