Hepatitis Delta Found in 15% of HIV/HBV Coinfected People, Increases Risk of Death

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Hepatitis Delta Found in 15% of HIV/HBV Coinfected People, Increases Risk of

Death

Details Category: Hepatitis Delta (HDV) Published on Thursday, 01 September 2011

00:00 Written by Liz Highleyman

Approximately 15% of people with HIV who test positive for hepatitis B surface

antigen (HBsAg) also carry hepatitis delta virus (HDV), a defective virus that

can only replicate in the presence of hepatitis B virus (HBV) but can lead to

more severe liver damage, according to a recent European study.

As described in the August 19, 2011, advance online edition of AIDS,

Soriano and fellow investigators with the EuroSIDA study aimed to learn more

about the prevalence, epidemiology, virological profile, and natural history of

hepatitis delta in HIV positive people.

HDV is a blood-borne virus like HBV and HIV, suggesting that injection users

infected via shared syringes or other injection equipment might be at high risk

of having HDV as well.

Out of more than 16,000 HIV positive individuals enrolled in the EuroSIDA

cohort, the investigators identified 1319 (7.9%) who had ever tested positive

for HBsAg, indicating exposure. The body often clears HBV on its own without

treatment, so many HBsAg positive people do not have current active hepatitis B.

During the latest follow-up visit, 1084 participants (6.5%) were currently HBsAg

positive. The HDV sub-study included 422 of these patients who had available

stored blood samples. The researchers tested samples for HDV using a commercial

enzyme immunoassay and measured HDV RNA viral load using real-time PCR.

Results

61 out of the 422 tested HIV/HBsAg positive patients also carried HDV

antibodies, a prevalence of 14.5%.

HDV was primarily seen among injection drug users, who are concentrated in

Southern and Eastern Europe: Russia and Eastern Europe: HDV prevalence 25%;

Southern Europe including Italy and Spain: 21%;

Central Europe, including France and Southern Germany: 11%;

Northern Europe, including the U.K., Scandinavia, and Northern Germany.

87.0% of participants who tested positive for HDV antibodies had detectable HDV

RNA -- indicating active viral replication -- with a median viral load of 1.76 x

107 copies/mL.

Overall, people triply infected with HDV had lower serum HBV DNA viral load

than HBsAg positive people without hepatitis delta.

This inhibitory effect of HDV on HBV replication was not seen, however, in

people with HBV genotype D.

HDV triple infection was not associated with more rapid progression to AIDS.

HDV was, however, significantly associated with a higher risk of death due to

liver-related causes and overall mortality.

The study authors concluded that most patients infected with HDV " exhibit

detectable HDV viremia, " and that " [v]iral interference between HBV and HDV is

manifest in all but HBV genotype D carriers, in whom overt co-replication of

both viruses occurs, which might result in enhanced liver damage. "

" Treatment of chronic hepatitis delta is a huge challenge, " they explained in

their discussion. HDV replicates using a human polymerase enzyme, so

nucleoside/nucleotide analog drugs designed to inhibit viral polymerases do not

block HDV replication. Current recommended therapy is pegylated interferon-alfa

(Pegasys or PegIntron) for at least 12 months. Some studies suggest that the

most potent nucleoside/nucleotide analogs, such as tenofovir (Viread), may be

beneficial for a subset of hepatitis delta patients, though this has mainly been

limited to people with HBV genotype A or hepatitis B " e " antigen (HBeAg).

" Most guidelines recommend that all HBsAg [positive] patients should be tested

for anti-HDV antibodies, " the researchers wrote. " Given that a fraction of

HDV-seropositive individuals may not actively replicate the virus, serum HDV RNA

should be measured and treatment be considered in patients with detectable

viremia, given that chronic hepatitis delta is associated with a high risk of

cirrhosis in HIV-infected patients...Failure to exclude HDV infection in HBsAg

carriers may result in an unexpected worse outcome and trigger unnecessary

search for other etiologies of liver disease. "

Investigator affiliations: Infectious Diseases, Hospital III, Madrid,

Spain; University College London Medical School, Royal Free Campus, London, UK;

Clinica Malattie Infettive e Tropicali, Milan, Italy; Infectious Diseases

Department, Hospital for Infectious Diseases, Warsaw, Poland; Infectious

Diseases Department, Western General Hospital, Edinburgh, UK; Infectious

Diseases Department, Hospital Santa , Lisbon, Portugal; Infectious Diseases

Department, St Pierre Hospital, Brussels, Belgium; Copenhagen HIV Programme,

Copenhagen, Denmark; Infectious Diseases Department, Rigshospitalet, Copenhagen,

Denmark; Infectious Diseases Department, Bonn University Hospital, Bonn,

Germany.

9/2/11

Reference

V Soriano, D Grint, A d’Arminio Monforte, et al. Hepatitis delta in HIV-infected

individuals in Europe. AIDS (abstract). August 19, 2011 (Epub ahead of print).