Association of HDV infection and HCC, hepatic decompensation, and all-cause and liver-related death in a national cohort

Binu V. John, Division of Gastroenterology and Hepatology, Department of Medicine, Miami VA Medical System, Miami, Florida, USA.
Dustin Bastaich, Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, USA.
Mahmoud Manouchehri Amoli, Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, USA.
Robert J. Wong, Division of Gastroenterology and Hepatology, Department of Medicine, Palo Alto VA Health System, Palo Alto, California, USA.
Donna M. Evon, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.
Shari S. Rogal, Center for Health Equity Research and Promotion, Pittsburgh VA Health System, Pittsburgh, Pennsylvania, USA.
David B. Ross, Division of Infectious Diseases, Department of Medicine, VA Washington DC Health Care, Washington, Columbia, USA.
Timothy R. Morgan, Division of Gastroenterology and Hepatology, Department of Medicine, Long Beach VA Health System, Irvine, California, USA.
Seth A. Spector, Department of Surgery, Miami VA Health System, and University of Miami Miller School of Medicine, Miami, Florida, USA.
Gabriel Villada, Department of Pathology, Miami VA Medical System, Miami, Florida, USA.
Hann-Hsiang Chao, Department of Radiation Oncology, Richmond VA Medical Center and Virginia Commonwealth University, Richmond, Virginia.
Bassam Dahman, Department of Health Policy, Virginia Commonwealth University, Richmond, Virginia.

Document Type

Journal Article

Publication Date

6-1-2025

Journal

Hepatology (Baltimore, Md.)

Volume

81

Issue

6

DOI

10.1097/HEP.0000000000001092

Keywords

HBV; HCV; cirrhosis; portal hypertension; viral hepatitis

Abstract

BACKGROUND AND AIMS: HDV infection is the most severe form of chronic hepatitis. However, studies on outcomes and causes of death in a US-born population, with primarily horizontal transmission of HDV, are lacking. The aim of this study was to conduct a national study of patients with hepatitis D to understand the natural history and outcomes compared to patients with HBV infection. APPROACH AND RESULTS: In a national cohort of 4817 veterans infected with HBV tested for HDV (99.6% US-born, 3.3% HDV-positive) over a 23-year period, we used multivariable models to identify the factors associated with a composite outcome of HCC, decompensation, and liver-related mortality, and all-cause mortality of patients with HDV compared to HBV mono-infection. HDV coinfection (vs. HBV mono-infection) was associated with a significantly higher incidence of composite liver-related outcomes at both 5 (23.84 vs. 7.98, p < 0.001) and 10 years (19.14 vs. 10.18, p < 0.001), respectively. The most common cause of death was liver-related (33.8% for HDV vs. 24.7% for HBV), followed by nonhepatic malignancies (15.6% vs. 14.8%), cardiac (11.7% vs. 15.2%), and lung disease (5.2% vs. 3.7%). In multivariable models, HDV was associated with an increased risk of composite liver outcomes (adjusted hazard ratio: 2.57, 95% CI: 1.87-3.52, p < 0.001) and all-cause mortality (adjusted hazard ratio: 1.52, 95% CI: 1.20-1.93, p < 0.001). CONCLUSIONS: In a predominantly US-born cohort of veterans, HDV coinfection was associated with an increased risk of liver-related outcomes and all-cause mortality. Our findings support widespread testing for early identification of HDV.

Department

Medicine

Link to Full Text

Share

COinS