Prevalence clinical characteristics of hepatitis delta virus (hdv) infected individuals in british columbia

Introduction: Globally, HDV is reported in 4.5-13% of chronic hepatitis B (CHB) patients. HDV and HBV co-infection is associated with progression to cirrhosis and higher risk of hepatocellular carcinoma (HCC). HDV prevalence in Canada is not fully elucidated. The purpose of the study was to describe the prevalence and clinical characteristics of HDV infection in CHB patients in a tertiary care centre. Methods: Retrospective study of HBsAg-positive patients >18 years of age tested for HDV Ab between April 2013 and October 2022. Data collected included HDV Ab status, patient demographics, comorbidities, alcohol use, fibrosis stage, and therapies utilized. Results: Among 663 HBsAg-positive patients tested for HDV Ab,10/663 (1.5%, 95% confidence interval [CI] 0.58-2.44) were HDV-Ab (+), with 8/10 (80%, 95% CI 0.55-1.05) of those confirmed HDV RNA(+). Average age of HDV patients was 57.8 (95% CI 52.7- 62.9) years, similar to HBV patients. Compared to HBV mono-infected patients, HBV-HDV co-infected patients were more likely to be male (90.0% vs 57.6%; P = 0.04), have decompensated liver disease (30.0% vs 1.4%; P < 0.0001) and less likely to be Asian (50.0% vs 80.9%; P = 0.014). One HBV-HDV co-infected patient was also HIV/HCV co-infected, and 2 had cleared HCV. One HDV patient had a known history of IVDU (10%, 95% CI 0.09 – 0.28). Mean ALT in HDV patients was 55.9, vs 34.3 in HBV mono group (P = 0.0508). 50% of HDV patients consumed any lifetime alcohol compared to 31.9% of HBV mono-infected patients (P = 0.22). HDV patients were more likely to have liver stiffness measurements >9.0 kPa 30% vs 8.9%, P = 0.02), and equally likely to have HCC 10% vs 2.5% (P = 0.13). Conclusion: The prevalence of HDV positivity in CHB patients in this tertiary care centre was 1.5%. This was less than a previously noted 4.8% prevalence of HDV positivity amongst HBsAg-positive patients enrolled in in the Canadian HBV Network between 2011-2019. Persons with HDV were more likely to be male, and have decompensated liver disease and less likely to be Asian than those with HBV mono-infection. Further studies to understand the burden of disease in other regions are needed. Table 1. - Comparison of additional demographics, hepatic outcomes, laboratory values, antiviral treatment experience, and co-morbidities in HBV mono-infected individuals (n = 653) compared with HDV–HBV co-infected individuals (n = 10) HDV-HBV co-infected (n = 10) HBV mono-infected (n = 653) P-value Ethnicity Asian 50% (5/10) 81% (529/653) 0.014 Caucasian 30% (3/10) 8.27% (54/653) 0.015 Middle Eastern 20% (2/10) 3.06% (20/653) 0.003 East Asian 0% 2.45% (16/653) 0.62 Black/African/Caribbean 0% 3.83% (25/653) 0.53 Hispanic 0% 1.38% (9/653) 0.71 BMI 26.8 (95% CI 24.26-29.34, n = 7) 24.17 (95% CI 23.8-24.53, n = 456) 0.08 Hepatic Outcomes Cirrhosis 20% (2/10) 3.68% (24/653) 0.008 Fatty Liver/Steatosis > = S1 57.14% (4/7) 53.89% (291/540) 0.86 Labs* GFR 80.8 (95% CI 65.35-96.25, n = 10) 90.58 (95% CI 8.94-92.22, n = 650) 0.15 HBeAb+ 25% (2/8) 22.17% (100/451) 0.85 HBV DNA Detectable 20% (2/10) 47.3% (307/649) 0.09 Current Treatment Antiviral therapy against HBV 60% (6/10) 50.08% (327/653) 0.53 Interferon 0% 0.15% (1/653) 0.9 Lamivudine 10% (1/10) 6.12% (40/653) 0.61 Tenofovir (TDF or TAF) 50% (5/10) 34.9% (228/653) 0.32 Entecavir 0% 7.5% (49/653) 0.37 Nucleos(t)ide inhibitor 0% 0.15% (1/653) 0.9 Comorbidities Diabetes 10% (1/10) 7.5% (49/653) 0.77 Hypertension 10% (1/10) 17.76% (116/653) 0.52 Dyslipidemia 0% 11.18% (73/653) 0.26 Continuous data are presented as mean (95% CI, n known). Categorical data are presented as mean % (n/n known). T tests were used for continuous data and chi-square tests were used for categorical data. Values of P < 0.05 are designated as significant.*Labs defined as most recent as of May 2023.