Prevalence and predictors for compensated Advanced Chronic Liver Disease (c-ACLD) in patients with chronic Hepatitis Delta Virus (HDV) infection.
OBJECTIVE
The study aimed to evaluate the prevalence and predictor factors for compensated advanced chronic liver disease (c-ACLD) in patients with hepatitis Delta virus (HDV) infection.


METHODS
This cross-sectional study included consecutive HDV-infected patients defined by positive anti-HDV. Patients with hepatitis C coinfection, liver transplantation or presence of conditions that limit liver (LSM) or spleen stiffness measurement (SSM) were excluded. Blood tests, abdominal ultrasound, SSM and LSM by transient elastography (FibroScan®) were performed at the same day. Alcohol consumption was quantified using the AUDIT score and c-ACLD was defined by LSM ≥ 15 kPa performed by an experimented operator blinded for clinical and laboratory data.


RESULTS
101 patients were eligible and few patients were excluded due to negative anti-HDV (n = 7), hepatitis C coinfection (n = 2), liver transplantation (n = 10) and limitation for LSM or SSM (n = 5). Therefore, 77 patients [61% male, age = 43 (IQR,36-52) years] were included. The prevalence of c-ACLD was 57% (n = 44/77). Patients with c-ACLD had a higher rate of detectable HBV viral load (p = 0.039), higher levels of transaminases, GGT, alkaline phosphatases, total bilirubin and INR (p<0.001 for all), as well as lower platelet count and albumin levels (p>0.001 for both) compared to those without c-ACLD. Patients with c-ACLD had higher SSM [65.2 (IQR,33.8-75.0) vs 21.8 (16.5-32.0) kPa; p<0.001] and higher splenic volume [475 (IQR,311-746) vs 154 (112-283) cm3; p<0.001] compared to those without. Detectable HBV viral load (>10 UI/ml), alkaline phosphatase (per IU/L) and GGT levels (per IU/L) were independently associated with c-ACLD in all multivariate models. Splenic volume [per cm3,OR = 1.01 (95%CI,1.01-1.02);p = 0.002], SSM [per kPa, OR = 1.04 (1.01-1.07);p = 0.012] and splenomegaly [yes vs no,OR = 28.45 (4.42-182.95);p<0.001] were independently associated with c-ACLD.


CONCLUSIONS
The prevalence of c-ACLD was high in patients with chronic HDV infection in western Amazon basin. HBV viral load, liver enzymes and splenic features can be used to predict severe liver disease in HDV-infected patients.
Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT HVD), Manaus, Amazonas, Brazil.
Ingrid
I
Couto
Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT HVD), Manaus, Amazonas, Brazil.
Marilu
M
Victoria
Laboratório de Pesquisa Clínica em DST/AIDS (LAPCLIN-AIDS), Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
Valdiléa G
VG
Veloso
Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT HVD), Manaus, Amazonas, Brazil.
Lorena
L
Rodrigues
Laboratório de Pesquisa Clínica em DST/AIDS (LAPCLIN-AIDS), Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
Beatriz
B
Grinsztejn
Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT HVD), Manaus, Brazil.|Instituto de Pesquisas Leônidas & Maria Deane - Fundação Oswaldo Cruz (FIOCRUZ), Manaus, Brazil.
Marcus
M
Lacerda
Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT HVD), Manaus, Amazonas, Brazil.
Flamir
F
Victoria
Laboratório de Pesquisa Clínica em DST/AIDS (LAPCLIN-AIDS), Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
Hugo
H
Perazzo
D000328:Adult; D060085:Coinfection / Q000453:epidemiology / Q000821:virology; D003430:Cross-Sectional Studies; D005260:Female; D016174:Hepacivirus / Q000472:pathogenicity; D006508:Hepatitis Antibodies / Q000276:immunology; D006515:Hepatitis B virus / Q000472:pathogenicity; D019694:Hepatitis B, Chronic / Q000453:epidemiology / Q000821:virology; D006526:Hepatitis C / Q000453:epidemiology / Q000821:virology; D019701:Hepatitis D, Chronic / Q000453:epidemiology* / Q000821:virology*; D003698:Hepatitis Delta Virus / Q000472:pathogenicity; D006801:Humans; D008099:Liver / Q000821:virology; D008107:Liver Diseases / Q000821:virology*; D008111:Liver Function Tests / Q000379:methods; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D019562:Viral Load / Q000379:methods
D006508:Hepatitis Antibodies