Prognosis

As with other types of viral hepatitis, (decompensated) cirrhosis, hepatocellular carcinoma (HCC), and liver-related mortality are potential complications of hepatitis D virus (HDV) infection.[66]

Patients with chronic HDV infection who have a higher risk of progression of liver disease include those with any of:[1]

  • Elevated aminotransferases

  • Elevated gamma-glutamyl transpeptidase (GGT) levels

  • Advanced stage of liver disease

  • Persistent HDV viraemia

  • High serum hepatitis B virus (HBV) DNA levels

  • Viral co-infection

  • A history of other conditions associated with chronic liver disease (e.g., obesity, alcohol abuse, diabetes).

HDV infects susceptible hosts via simultaneous co-infection with HBV or via superinfection of an individual already infected with HBV. Very early studies suggest that both superinfection and co-infection with HDV increase the risk of fulminant hepatitis twofold compared with acute HBV infection alone.[67]

The natural history of HDV infection is likely more severe than that of HBV infection alone and appears to be related to the degree of HDV replication.[18][68][69]

An Italian study followed 299 patients with chronic HDV infections for almost 30 years and noted that 46 patients (15.4%) developed HCC, 43 (14.4%) developed ascites, 63 (21.1%) died, and 29 (9.7%) received liver transplantation. HDV replication was the only independent predictor of mortality.[18] Similar findings were noted in a Greek study of almost 5000 patients with chronic HBV infection. Patients with a positive anti-HDV (4.2%) had more active and advanced disease at baseline, were more likely to have cirrhosis at a younger age, and were more likely to develop a liver related event (20.0% vs. 8.5%) over a median follow-up of 4.2 years, compared with patients negative for anti-HDV.[69] After adjusting for clinical and serological differences, the increased risk of complications in patients with compensated cirrhosis with HDV/HBV co-infection compared with HBV infection alone were 3.2-fold for HCC, 2.2-fold for any decompensation, and 2.0-fold for mortality.[68]

There are some geographical differences in the risk of complications, with studies in Taiwan, where genotype 2 HDV predominates, suggesting that the risk of fulminant liver failure and cirrhosis or HCC is decreased compared with genotype 1 disease (found mainly in North America, Europe, the Middle East, and north Africa).[7][8] Conversely, genotypes 1 and 3 (which predominate in South America) lead to more severe disease and genotype 5 is associated with better response to therapy.[5][6]

Use of this content is subject to our disclaimer