Hepatitis Delta Virus Testing, Prevalence, and Liver-Related Outcomes Among US Veterans With Chronic Hepatitis B

Gastro hep advances Pub Date : 2025-01-01 DOI:10.1016/j.gastha.2024.10.015

Robert J. Wong , Zeyuan Yang , Janice H. Jou , Binu V. John , Joseph K. Lim , Ramsey Cheung

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Abstract

Background and Aims

Hepatitis delta virus (HDV) infection in patients with chronic hepatitis B (CHB) is associated with worse liver-related outcomes. We aim to comprehensively evaluate HDV testing, diagnosis, and liver-related outcomes among a national cohort of US Veterans with CHB.

Methods

US Veterans with CHB from 2010 to 2023 were evaluated to determine trends in HDV testing (anti-HDV antibody, HDV RNA) and proportion positive among those tested. HDV positive patients were 1:2 propensity score matched to CHB patients who were HDV negative to evaluate incidence (per 100,000 person-years) of cirrhosis, hepatic decompensation, or hepatocellular carcinoma using competing risks Nelson-Aalen methods for estimating cumulative hazards.

Results

Among the 27,548 CHB patients identified, 16.1% completed HDV testing, among whom 3.25% (n = 144) were positive. After excluding patients with cirrhosis or HCC at baseline, 71 patients with HDV (median follow-up 5.3 years, interquartile range 2.5–7.6) were propensity score matched to 140 CHB patients without HDV (median follow-up 4.5 years, interquartile range 2.6–8.1). Compared to CHB patients without HDV, those with concurrent HDV had significantly greater incidence of cirrhosis (4.39 vs 1.30 per 100,000 person-years, P < .01) and hepatic decompensation (2.18 vs 0.41 per 100,000 person-years, P = .01).

Conclusion

Among a national cohort of US Veterans with CHB, low rates of HDV testing were observed. This is concerning given that patients with concurrent HDV infection had >3 times and >5 times greater risks of cirrhosis and hepatic decompensation, respectively, compared to CHB patients without HDV, highlighting the importance of timely HDV diagnosis and treatment.

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美国慢性乙型肝炎退伍军人的丁型肝炎病毒检测、流行和肝脏相关结果

背景和目的慢性乙型肝炎（CHB）患者感染丁型肝炎病毒（HDV）与较差的肝脏相关预后相关。我们的目的是全面评估美国慢性乙型肝炎退伍军人国家队列中HDV检测、诊断和肝脏相关结果。方法对2010 ~ 2023年CHB退伍军人的HDV（抗HDV抗体、HDV RNA）检测趋势及阳性比例进行评估。采用竞争风险Nelson-Aalen方法估计累积风险，将HDV阳性患者与HDV阴性的CHB患者进行1:2倾向评分匹配，以评估肝硬化、肝失代偿或肝细胞癌的发生率（每100,000人年）。结果在27548例CHB患者中，16.1%完成了HDV检测，其中3.25% （n = 144）呈阳性。在基线时排除肝硬化或HCC患者后，71例HDV患者（中位随访5.3年，四分位数范围2.5-7.6）与140例无HDV的CHB患者（中位随访4.5年，四分位数范围2.6-8.1）进行倾向评分匹配。与没有HDV的CHB患者相比，并发HDV的CHB患者肝硬化发生率显著更高(4.39 vs 1.30 / 100,000人年，P <；.01)和肝失代偿（2.18 vs 0.41 / 100000人年，P = .01）。结论：在美国慢性乙型肝炎退伍军人的全国队列中，观察到HDV检测率低。考虑到合并HDV感染的患者发生肝硬化和肝功能失代偿的风险分别是未合并HDV的CHB患者的3倍和5倍，这一点令人担忧，这突出了及时诊断和治疗HDV的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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