Hepatitis delta infection among persons living with HIV in Europe

C Béguelin; A Atkinson; A Boyd; K Falconer; N Kirkby; F Suter-Riniker; H F Günthard; J K Rockstroh; A Mocroft; A Rauch; L Peters; G Wandeler; EuroSIDA and SHCS

doi:10.1111/liv.15519

Hepatitis delta infection among persons living with HIV in Europe

C Béguelin^*, A Atkinson, A Boyd, K Falconer, N Kirkby, F Suter-Riniker, H F Günthard, J K Rockstroh, A Mocroft, A Rauch, L Peters, G Wandeler, EuroSIDA and SHCS

^*Corresponding author for this work

Abstract

BACKGROUND AND AIMS: A high prevalence of hepatitis delta virus (HDV) infection, the most severe form of viral hepatitis, has been reported among persons living with HIV (PLWH) in Europe. We analysed data from a large HIV cohort collaboration to characterize HDV epidemiological trends across Europe, as well as its impact on clinical outcomes.

METHODS: All PLWH with a positive hepatitis B surface antigen (HBsAg) in the Swiss HIV Cohort Study and EuroSIDA between 1988 and 2019 were tested for anti-HDV antibodies and, if positive, for HDV RNA. Demographic and clinical characteristics at initiation of antiretroviral therapy were compared between HDV-positive and HDV-negative individuals using descriptive statistics. The associations between HDV infection and overall mortality, liver-related mortality as well as hepatocellular carcinoma (HCC) were assessed using cumulative incidence plots and cause-specific multivariable Cox regression.

RESULTS: Of 2793 HBsAg-positive participants, 1556 (56%) had stored serum available and were included. The prevalence of HDV coinfection was 15.2% (237/1556, 95% confidence interval [CI]: 13.5%-17.1%) and 66% (132/200) of HDV-positive individuals had active HDV replication. Among persons who inject drugs (PWID), the prevalence of HDV coinfection was 50.5% (182/360, 95% CI: 45.3%-55.7%), with similar estimates across Europe, compared to 4.7% (52/1109, 95% CI: 3.5%-5.9%) among other participants. During a median follow-up of 10.8 years (interquartile range 5.6-17.8), 82 (34.6%) HDV-positive and 265 (20.1%) HDV-negative individuals died. 41.5% (34/82) of deaths were liver-related in HDV-positive individuals compared to 17.7% (47/265) in HDV-negative individuals. HDV infection was associated with overall mortality (adjusted hazard ratio 1.6; 95% CI 1.2-2.1), liver-related death (2.9, 1.6-5.0) and HCC (6.3, 2.5-16.0).

CONCLUSION: We found a very high prevalence of hepatitis delta among PWID across Europe. Among PLWH who do not inject drugs, the prevalence was similar to that reported from populations without HIV. HDV coinfection was associated with liver-related mortality and HCC incidence.

Original language	English
Journal	Liver international : official journal of the International Association for the Study of the Liver
Volume	43
Issue number	4
Pages (from-to)	819-828
Number of pages	10
ISSN	1478-3223
DOIs	https://doi.org/10.1111/liv.15519
Publication status	Published - Apr 2023

Keywords

Carcinoma, Hepatocellular
Cohort Studies
Coinfection/epidemiology
Drug Users
Europe/epidemiology
HIV Infections/complications
Hepatitis A/complications
Hepatitis B Surface Antigens
Hepatitis B virus
Hepatitis B/complications
Hepatitis D/epidemiology
Hepatitis Delta Virus/genetics
Humans
Liver Neoplasms/epidemiology
Prevalence
Substance Abuse, Intravenous/complications
PLWH
HCC
prevalence
HIV
Hepatitis Delta

Access to Document

10.1111/liv.15519

Cite this

Béguelin, C., Atkinson, A., Boyd, A., Falconer, K., Kirkby, N., Suter-Riniker, F., Günthard, H. F., Rockstroh, J. K., Mocroft, A., Rauch, A., Peters, L., Wandeler, G., & EuroSIDA and SHCS (2023). Hepatitis delta infection among persons living with HIV in Europe. Liver international : official journal of the International Association for the Study of the Liver, 43(4), 819-828. https://doi.org/10.1111/liv.15519

Béguelin, C, Atkinson, A, Boyd, A, Falconer, K, Kirkby, N, Suter-Riniker, F, Günthard, HF, Rockstroh, JK, Mocroft, A, Rauch, A, Peters, L, Wandeler, G & EuroSIDA and SHCS 2023, 'Hepatitis delta infection among persons living with HIV in Europe', Liver international : official journal of the International Association for the Study of the Liver, vol. 43, no. 4, pp. 819-828. https://doi.org/10.1111/liv.15519

@article{07af59289e96470c95f47297608e51e7,

title = "Hepatitis delta infection among persons living with HIV in Europe",

abstract = "BACKGROUND AND AIMS: A high prevalence of hepatitis delta virus (HDV) infection, the most severe form of viral hepatitis, has been reported among persons living with HIV (PLWH) in Europe. We analysed data from a large HIV cohort collaboration to characterize HDV epidemiological trends across Europe, as well as its impact on clinical outcomes.METHODS: All PLWH with a positive hepatitis B surface antigen (HBsAg) in the Swiss HIV Cohort Study and EuroSIDA between 1988 and 2019 were tested for anti-HDV antibodies and, if positive, for HDV RNA. Demographic and clinical characteristics at initiation of antiretroviral therapy were compared between HDV-positive and HDV-negative individuals using descriptive statistics. The associations between HDV infection and overall mortality, liver-related mortality as well as hepatocellular carcinoma (HCC) were assessed using cumulative incidence plots and cause-specific multivariable Cox regression.RESULTS: Of 2793 HBsAg-positive participants, 1556 (56%) had stored serum available and were included. The prevalence of HDV coinfection was 15.2% (237/1556, 95% confidence interval [CI]: 13.5%-17.1%) and 66% (132/200) of HDV-positive individuals had active HDV replication. Among persons who inject drugs (PWID), the prevalence of HDV coinfection was 50.5% (182/360, 95% CI: 45.3%-55.7%), with similar estimates across Europe, compared to 4.7% (52/1109, 95% CI: 3.5%-5.9%) among other participants. During a median follow-up of 10.8 years (interquartile range 5.6-17.8), 82 (34.6%) HDV-positive and 265 (20.1%) HDV-negative individuals died. 41.5% (34/82) of deaths were liver-related in HDV-positive individuals compared to 17.7% (47/265) in HDV-negative individuals. HDV infection was associated with overall mortality (adjusted hazard ratio 1.6; 95% CI 1.2-2.1), liver-related death (2.9, 1.6-5.0) and HCC (6.3, 2.5-16.0).CONCLUSION: We found a very high prevalence of hepatitis delta among PWID across Europe. Among PLWH who do not inject drugs, the prevalence was similar to that reported from populations without HIV. HDV coinfection was associated with liver-related mortality and HCC incidence.",

keywords = "Carcinoma, Hepatocellular, Cohort Studies, Coinfection/epidemiology, Drug Users, Europe/epidemiology, HIV Infections/complications, Hepatitis A/complications, Hepatitis B Surface Antigens, Hepatitis B virus, Hepatitis B/complications, Hepatitis D/epidemiology, Hepatitis Delta Virus/genetics, Humans, Liver Neoplasms/epidemiology, Prevalence, Substance Abuse, Intravenous/complications, PLWH, HCC, prevalence, HIV, Hepatitis Delta",

author = "C B{\'e}guelin and A Atkinson and A Boyd and K Falconer and N Kirkby and F Suter-Riniker and G{\"u}nthard, {H F} and Rockstroh, {J K} and A Mocroft and A Rauch and L Peters and G Wandeler and {EuroSIDA and SHCS}",

year = "2023",

month = apr,

doi = "10.1111/liv.15519",

language = "English",

volume = "43",

pages = "819--828",

journal = "Liver International",

issn = "1478-3223",

publisher = "Wiley-Blackwell Munksgaard",

number = "4",

}

TY - JOUR

T1 - Hepatitis delta infection among persons living with HIV in Europe

AU - Béguelin, C

AU - Atkinson, A

AU - Boyd, A

AU - Falconer, K

AU - Kirkby, N

AU - Suter-Riniker, F

AU - Günthard, H F

AU - Rockstroh, J K

AU - Mocroft, A

AU - Rauch, A

AU - Peters, L

AU - Wandeler, G

AU - EuroSIDA and SHCS

PY - 2023/4

Y1 - 2023/4

N2 - BACKGROUND AND AIMS: A high prevalence of hepatitis delta virus (HDV) infection, the most severe form of viral hepatitis, has been reported among persons living with HIV (PLWH) in Europe. We analysed data from a large HIV cohort collaboration to characterize HDV epidemiological trends across Europe, as well as its impact on clinical outcomes.METHODS: All PLWH with a positive hepatitis B surface antigen (HBsAg) in the Swiss HIV Cohort Study and EuroSIDA between 1988 and 2019 were tested for anti-HDV antibodies and, if positive, for HDV RNA. Demographic and clinical characteristics at initiation of antiretroviral therapy were compared between HDV-positive and HDV-negative individuals using descriptive statistics. The associations between HDV infection and overall mortality, liver-related mortality as well as hepatocellular carcinoma (HCC) were assessed using cumulative incidence plots and cause-specific multivariable Cox regression.RESULTS: Of 2793 HBsAg-positive participants, 1556 (56%) had stored serum available and were included. The prevalence of HDV coinfection was 15.2% (237/1556, 95% confidence interval [CI]: 13.5%-17.1%) and 66% (132/200) of HDV-positive individuals had active HDV replication. Among persons who inject drugs (PWID), the prevalence of HDV coinfection was 50.5% (182/360, 95% CI: 45.3%-55.7%), with similar estimates across Europe, compared to 4.7% (52/1109, 95% CI: 3.5%-5.9%) among other participants. During a median follow-up of 10.8 years (interquartile range 5.6-17.8), 82 (34.6%) HDV-positive and 265 (20.1%) HDV-negative individuals died. 41.5% (34/82) of deaths were liver-related in HDV-positive individuals compared to 17.7% (47/265) in HDV-negative individuals. HDV infection was associated with overall mortality (adjusted hazard ratio 1.6; 95% CI 1.2-2.1), liver-related death (2.9, 1.6-5.0) and HCC (6.3, 2.5-16.0).CONCLUSION: We found a very high prevalence of hepatitis delta among PWID across Europe. Among PLWH who do not inject drugs, the prevalence was similar to that reported from populations without HIV. HDV coinfection was associated with liver-related mortality and HCC incidence.

AB - BACKGROUND AND AIMS: A high prevalence of hepatitis delta virus (HDV) infection, the most severe form of viral hepatitis, has been reported among persons living with HIV (PLWH) in Europe. We analysed data from a large HIV cohort collaboration to characterize HDV epidemiological trends across Europe, as well as its impact on clinical outcomes.METHODS: All PLWH with a positive hepatitis B surface antigen (HBsAg) in the Swiss HIV Cohort Study and EuroSIDA between 1988 and 2019 were tested for anti-HDV antibodies and, if positive, for HDV RNA. Demographic and clinical characteristics at initiation of antiretroviral therapy were compared between HDV-positive and HDV-negative individuals using descriptive statistics. The associations between HDV infection and overall mortality, liver-related mortality as well as hepatocellular carcinoma (HCC) were assessed using cumulative incidence plots and cause-specific multivariable Cox regression.RESULTS: Of 2793 HBsAg-positive participants, 1556 (56%) had stored serum available and were included. The prevalence of HDV coinfection was 15.2% (237/1556, 95% confidence interval [CI]: 13.5%-17.1%) and 66% (132/200) of HDV-positive individuals had active HDV replication. Among persons who inject drugs (PWID), the prevalence of HDV coinfection was 50.5% (182/360, 95% CI: 45.3%-55.7%), with similar estimates across Europe, compared to 4.7% (52/1109, 95% CI: 3.5%-5.9%) among other participants. During a median follow-up of 10.8 years (interquartile range 5.6-17.8), 82 (34.6%) HDV-positive and 265 (20.1%) HDV-negative individuals died. 41.5% (34/82) of deaths were liver-related in HDV-positive individuals compared to 17.7% (47/265) in HDV-negative individuals. HDV infection was associated with overall mortality (adjusted hazard ratio 1.6; 95% CI 1.2-2.1), liver-related death (2.9, 1.6-5.0) and HCC (6.3, 2.5-16.0).CONCLUSION: We found a very high prevalence of hepatitis delta among PWID across Europe. Among PLWH who do not inject drugs, the prevalence was similar to that reported from populations without HIV. HDV coinfection was associated with liver-related mortality and HCC incidence.

KW - Carcinoma, Hepatocellular

KW - Cohort Studies

KW - Coinfection/epidemiology

KW - Drug Users

KW - Europe/epidemiology

KW - HIV Infections/complications

KW - Hepatitis A/complications

KW - Hepatitis B Surface Antigens

KW - Hepatitis B virus

KW - Hepatitis B/complications

KW - Hepatitis D/epidemiology

KW - Hepatitis Delta Virus/genetics

KW - Humans

KW - Liver Neoplasms/epidemiology

KW - Prevalence

KW - Substance Abuse, Intravenous/complications

KW - PLWH

KW - HCC

KW - prevalence

KW - HIV

KW - Hepatitis Delta

UR - http://www.scopus.com/inward/record.url?scp=85146981955&partnerID=8YFLogxK

U2 - 10.1111/liv.15519

DO - 10.1111/liv.15519

M3 - Journal article

C2 - 36625770

VL - 43

SP - 819

EP - 828

JO - Liver International

JF - Liver International

SN - 1478-3223

IS - 4

ER -

Hepatitis delta infection among persons living with HIV in Europe

Abstract

Keywords

Access to Document

Other files and links

Fingerprint

Cite this