title: Outcome of chronic delta hepatitis in Italy: a long-term cohort study.
abstract: OBJECTIVE
  To investigate the impact of HDV infection on morbidity and mortality of patients.
  
  
  METHODS
  This was a retrospective study on 188 patients that underwent a program of periodic surveillance until 2008. The demographic data, stage of liver disease, treatment efficacy, development of liver complications (ascites, oesophageal bleeding, encephalopathy), and survival were registered. A Cox regression analysis was carried out to determine the impact of viral and patient features on survival.
  
  
  RESULTS
  At baseline, 126 patients (67%) tested positive for serum IgM anti-HDV antibodies, 171 (91%) for anti-HBe, 175 (93%) for serum HDV-RNA, and 61 (33%) for serum HBV-DNA. Eighty-two patients (43%) had chronic hepatitis at histology; the remaining 106 individuals had a clinical/histological diagnosis of cirrhosis. Ninety-six patients received interferon (n = 90) or lamivudine (n = 6) therapy, and 27 of them (30%) attained a sustained response. During follow up, 21 patients with chronic hepatitis progressed to cirrhosis. Of the 127 cirrhotic patients, hepatic decompensation occurred in 42 patients (33%) and hepatocellular carcinoma in 17 (13%). The 5- and 10-year survival free of events were 96.8% and 81.9%, respectively, for patients with chronic hepatitis, and 83.9% and 59.4% for cirrhotics (p<0.01). At multivariate analysis, lack of antiviral therapy (p = 0.01), cirrhosis at presentation (p<0.01), and male sex (p = 0.03) independently predicted a worse outcome.
  
  
  CONCLUSIONS
  HDV liver disease lasts several decades. Half of all patients who develop cirrhosis later will advance to liver failure. At present, interferon therapy is recommended as soon as possible to slow or alter the natural course of liver disease.
authors.affiliation: Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni, Rotondo, Italy. g.niro@operapadrepio.it
authors.forename: Grazia Anna
authors.initials: GA
authors.lastname: Niro
authors.forename: Antonina
authors.initials: A
authors.lastname: Smedile
authors.forename: Antonio Massimo
authors.initials: AM
authors.lastname: Ippolito
authors.forename: Alessia
authors.initials: A
authors.lastname: Ciancio
authors.forename: Rosanna
authors.initials: R
authors.lastname: Fontana
authors.forename: Antonella
authors.initials: A
authors.lastname: Olivero
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Valvano
authors.forename: Maria Lorena
authors.initials: ML
authors.lastname: Abate
authors.forename: Domenica
authors.initials: D
authors.lastname: Gioffreda
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Caviglia
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzetto
authors.forename: Angelo
authors.initials: A
authors.lastname: Andriulli
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D019701:Hepatitis D, Chronic / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D007558:Italy; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000209:etiology; D008113:Liver Neoplasms / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome