Hepatitis Delta Coinfection Rates and All-Cause Mortality Among Hepatitis B-Infected Veterans in the USA.

IF 2.5 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Adeel A Butt, Peng Yan, Rahel Iwnetu, Amyn A Malik, Obaid S Shaikh, Jacqueline G O'Leary, Roger Bedimo
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Abstract

Screening for hepatitis D virus (HDV) is recommended for all individuals with hepatitis B virus (HBV) infection. Coinfected individuals experience more severe liver-related outcomes. We determined the HDV testing and coinfection rates and all-cause mortality among those infected with HBV. We used the US Department of Veterans Affairs (VA) healthcare system's national databases to identify individuals with HBV infection. We determined the proportion of individuals referred to gastroenterologists/hepatologists, or infectious diseases providers, and the proportion screened and tested positive for HDV. We calculated the HBV treatment rates, defined as ≥ 3 months of continuous prescription with an approved drug. Finally, we calculated all-cause mortality stratified by HDV coinfection and HBV treatment status. Among 44,951 individuals with at least one positive HBsAg, HBeAg or HBV DNA test, 5964 (13.3%) were screened for HDV (180 [3.0%] tested positive), and 28,291 (62.9%) were referred to gastroenterology/hepatology or infectious diseases. Treatment for HBV was prescribed for 73 (40.5%) of HDV-coinfected and 2425 (41.9%) HDV-uninfected individuals. All-cause mortality rate per 100 person-years was lower among those without HDV coinfection (2.98 for untreated HBV, 2.53 for treated HBV; p < 0.001) compared with those with HDV coinfection (5.14 for untreated HBV, 3.0 for treated HBV; p = 0.02). Kaplan-Meier curves demonstrated a significantly higher mortality among HDV-coinfected individuals who were not treated for HBV (log-rank p < 0.0001). Screening rates for HDV among HBV-infected individuals are suboptimal. While HDV coinfection is associated with higher all-cause mortality, HBV treatment may confer a survival benefit.

美国感染乙型肝炎的退伍军人中三角洲肝炎合并感染率和全因死亡率。
建议对所有乙型肝炎病毒(HBV)感染者进行丁型肝炎病毒(HDV)筛查。合并感染者会出现更严重的肝脏相关后果。我们确定了 HBV 感染者的 HDV 检测率、合并感染率和全因死亡率。我们使用美国退伍军人事务部(VA)医疗保健系统的国家数据库来识别 HBV 感染者。我们确定了转诊至胃肠病学家/肝病学家或传染病提供者的患者比例,以及筛查并检测出 HDV 阳性的患者比例。我们计算了 HBV 治疗率,HBV 治疗率的定义是连续使用批准药物≥ 3 个月。最后,我们根据 HDV 合并感染和 HBV 治疗情况计算了全因死亡率。在 44951 名至少有一次 HBsAg、HBeAg 或 HBV DNA 检测呈阳性的患者中,5964 人(13.3%)接受了 HDV 筛查(180 人[3.0%] 检测呈阳性),28291 人(62.9%)被转诊至胃肠病学/肝病学或传染病学。73名(40.5%)HDV合并感染者和2425名(41.9%)HDV未感染者接受了HBV治疗。未合并感染 HDV 的患者每 100 人年的全因死亡率较低(未治疗 HBV 的患者为 2.98,治疗 HBV 的患者为 2.53;P<0.05)。
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来源期刊
Journal of Viral Hepatitis
Journal of Viral Hepatitis 医学-病毒学
CiteScore
6.00
自引率
8.00%
发文量
138
审稿时长
1.5 months
期刊介绍: The Journal of Viral Hepatitis publishes reviews, original work (full papers) and short, rapid communications in the area of viral hepatitis. It solicits these articles from epidemiologists, clinicians, pathologists, virologists and specialists in transfusion medicine working in the field, thereby bringing together in a single journal the important issues in this expanding speciality. The Journal of Viral Hepatitis is a monthly journal, publishing reviews, original work (full papers) and short rapid communications in the area of viral hepatitis. It brings together in a single journal important issues in this rapidly expanding speciality including articles from: virologists; epidemiologists; clinicians; pathologists; specialists in transfusion medicine.
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