title: Antiviral treatment and liver-related complications in hepatitis delta.
abstract: Hepatitis delta virus (HDV) is the most severe form of viral hepatitis. Pegylated interferon alfa (PEG-IFNα) is effective in only 25%-30% of patients and is associated with frequent side effects. The aim of this study was to analyze the clinical long-term outcome of hepatitis delta in relation to different antiviral treatment strategies. We studied 136 anti-HDV-positive patients who were followed for at least 6 months in a retrospective single-center cohort (mean time of follow-up, 5.2 years; range, 0.6-18.8). Liver cirrhosis was already present in 62 patients at first presentation. Twenty-nine percent of patients did not receive any antiviral treatment, 38% were treated with interferon alfa (IFNα)-based therapies, and 33% received nucleos(t)ide analogues (NAs) only. Clinical endpoints defined as hepatic decompensation (ascites, encephalopathy, and variceal bleeding), hepatocellular carcinoma, liver transplantation, and liver-related death developed in 55 patients (40%). Patients who received IFNα-based therapies developed clinical endpoints less frequently than those treated with NA (P = 0.02; HR, 4.0) or untreated patients (P = 0.05; HR, 2.2; 17%, 64%, and 44%), respectively, which was significant in both chi-square and Kaplan-Meier analysis. In addition, considering various clinical and virological parameters, IFNα therapy was independently associated with a more benign clinical long-term outcome in multivariate logistic regression analysis (P = 0.04; odds ratio, 0.25; 95% confidence interval, 0.07-0.9). Loss of HDV RNA during follow-up was more frequent in IFNα-treated patients and strongly linked with a lower likelihood to experience liver-related complications.
  
  
  
  IFNα-based antiviral therapy of hepatitis delta was independently associated with a lower likelihood for clinical disease progression. Durable undetectability of HDV RNA is a valid surrogate endpoint in the treatment of hepatitis delta. (Hepatology 2017;65:414-425).
authors: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
authors: Anika
authors: A
authors: Wranke
authors: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
authors: Beatriz Calle
authors: BC
authors: Serrano
authors: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.|German Center for Infection Research (DZIF), Partner Side Hannover Medical School, Hannover, Germany.
authors: Benjamin
authors: B
authors: Heidrich
authors: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
authors: Janina
authors: J
authors: Kirschner
authors: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
authors: Birgit
authors: B
authors: Bremer
authors: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
authors: Patrick
authors: P
authors: Lehmann
authors: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.|German Center for Infection Research (DZIF), Partner Side Hannover Medical School, Hannover, Germany.
authors: Svenja
authors: S
authors: Hardtke
authors: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
authors: Katja
authors: K
authors: Deterding
authors: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
authors: Kerstin
authors: K
authors: Port
authors: Institute for Biometry, Hannover Medical School, Germany.
authors: Max
authors: M
authors: Westphal
authors: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.|German Center for Infection Research (DZIF), Partner Side Hannover Medical School, Hannover, Germany.|Integrated Research and Treatment Center Transplantation, Hannover Medical School, Germany.
authors: Michael P
authors: MP
authors: Manns
authors: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.|German Center for Infection Research (DZIF), Partner Side Hannover Medical School, Hannover, Germany.
authors: Markus
authors: M
authors: Cornberg
authors: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.|German Center for Infection Research (DZIF), Partner Side Hannover Medical School, Hannover, Germany.|Integrated Research and Treatment Center Transplantation, Hannover Medical School, Germany.
authors: Heiner
authors: H
authors: Wedemeyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002423:Cause of Death; D016009:Chi-Square Distribution; D015331:Cohort Studies; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D003699:Hepatitis D / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D003698:Hepatitis Delta Virus / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D016898:Interferon-alpha / Q000009:adverse effects / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000187:drug effects / Q000473:pathology; D008103:Liver Cirrhosis / Q000209:etiology / Q000401:mortality / Q000473:pathology*; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality / Q000473:pathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha