title: Hepatitis delta is a major determinant of liver decompensation events and death in HIV-infected patients.
abstract: BACKGROUND
  Coinfection with hepatitis viruses is common in individuals infected with human immunodeficiency virus (HIV) and has become a leading cause of complications and death in those receiving antiretroviral therapy (ART).
  
  
  METHODS
  We retrospectively examined the effect of coinfection with hepatitis B, C, and/or D viruses (HBV, HCV, HDV, respectively) on liver decompensation events (ascites, variceal bleeding, encephalopathy, and/or hepatocellular carcinoma) and liver-related mortality in HIV-positive patients on regular follow-up since the year 2004 at a reference HIV clinic in Madrid, Spain.
  
  
  RESULTS
  A total of 1147 HIV-infected patients (mean age, 42 years; 81% males; 46% intravenous drug users, 85.4% on ART) were analyzed. Mean follow-up was 81.2 ± 17.8 months. At baseline, 521 patients (45.4%) were HCV-antibody positive, 85 (7.4%) were hepatitis B surface antigen positive, and 17 (1.5%) were anti-HDV positive. A total of 233 HIV/HCV-coinfected patients received antiviral therapy for HCV, of whom 106 (45%) achieved sustained virologic response (SVR). Overall, 15 patients died of liver-related complications and 26 developed hepatic decompensation events. Taking as controls the 524 HIV-monoinfected patients, HDV coinfection (adjusted hazard ratio [AHR], 7.5; 95% confidence interval [CI], 1.84-30.8; P = .005) and baseline liver stiffness (AHR, 1.1; 95% CI, 1.07-1.13; P < .0001) were associated with a higher rate of liver-related morbidity and mortality. In contrast, SVR following hepatitis C therapy in HIV/HCV-coinfected patients was protective (AHR, 0.11; 95% CI, .01-.86; P = .03).
  
  
  CONCLUSIONS
  Hepatitis delta is associated with a high rate of death and liver decompensation events in HIV-infected patients on ART.
authors.affiliation: Department of Infectious Diseases, Hospital Carlos III.
authors.forename: José Vicente
authors.initials: JV
authors.lastname: Fernández-Montero
authors.forename: Eugenia
authors.initials: E
authors.lastname: Vispo
authors.forename: Pablo
authors.initials: P
authors.lastname: Barreiro
authors.forename: Rocío
authors.initials: R
authors.lastname: Sierra-Enguita
authors.forename: Carmen
authors.initials: C
authors.lastname: de Mendoza
authors.forename: Pablo
authors.initials: P
authors.lastname: Labarga
authors.forename: Vincent
authors.initials: V
authors.lastname: Soriano
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D060085:Coinfection / Q000150:complications / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology; D003699:Hepatitis D / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D017093:Liver Failure / Q000453:epidemiology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV; cirrhosis; death; hepatitis (HBV, HCV, and HDV)