Clinical outcomes in patients with hepatitis D, cirrhosis and persistent hepatitis B virus replication, and receiving long‐term tenofovir or entecavir. Issue 8 (21st February 2019)

• Record Type: Journal Article
• Authors: Brancaccio, Giuseppina; Fasano, Massimo; Grossi, Adriano; Santantonio, Teresa Antonia; Gaeta, Giovanni B.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 49:Issue 8(2019)
• Page Start: 1071
• Page End: 1076
• Publication Date: 2019-02-21
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.15188
• Languages: English
• ISSNs: 0269-2813

Abstract

Summary: Background: Suppression of hepatitis B virus (HBV) replication with nucelos(t)ide analogues should be considered for patients with chronic hepatitis D virus (HDV) infection and ongoing HBV replication. Aim: To verify the clinical outcome after long‐term entecavir or tenofovir treatment in patients with advanced fibrosis/cirrhosis, ineligible to peg‐interferon therapy. Methods: Patients were prospectively followed‐up at 3‐6 month intervals; measured outcomes were decompensation, hepatocellular carcinoma (HCC), liver transplant and liver related death. HBV monoinfected patients receiving the same treatment served as reference after 1:1 matching by age, gender, platelet count, albumin level, bilirubin and INR. Results: 56 HDV patients (48 with cirrhosis; median follow‐up 50 months) were enrolled; all achieved HBV DNA suppression. Death or liver transplant occurred in 19 patients, with a rate (n/1000 patient‐months) of 2.92 in HDV patients vs 0.38 in HBV monoinfected patients ( P < 0.001); similarly, decompensation occurred at a rate of 1.53 vs 0.13 ( P = 0.015), respectively, and the rate of HCC was almost thrice in HDV cohort (3.12 vs 1.12; P = 0.02) Platelet count, Child‐Pugh score and marginally HDV infection were associated with HCC development. Conclusion: Patients with HDV infection and advanced liver disease maintain an increased risk of severe clinical events as compared with HBV monoinfected patients, during prolonged HBV DNA suppression with potent NA.