Influence of hepatitis delta virus infection on morbidity and mortality in compensated cirrhosis type B
- G Fattovicha,
- G Giustinab,
- E Christensenc,
- M Pantalenaa,
- I Zagnia,
- G Realdid,
- S W Schalme,
- the European Concerted Action on Viral Hepatitis (Eurohep)
- aServizio Autonomo Clinicizzato di Gastroenterologia, University of Verona, Italy, bDipartimento di Medicina Clinica e Sperimentale, Clinica Medica 2a, University of Padova, Italy, cDepartment of Internal Medicine I, Bispebjerg University Hospital, Copenhagen, Denmark, dIstituto di Clinica Medica, University of Sassari, Italy, eHepatogastroenterology, Erasmus University Hospital Dijkzigt, Rotterdam, The Netherlands
- Dr G Fattovich, Servizio Autonomo Clinicizzato di Gastroenterologia, Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Università di Verona, Via delle Menegone 10, 37134 Verona, Italy
- Accepted 9 September 1999
BACKGROUND The effect of hepatitis delta virus (HDV) infection on the clinical course of cirrhosis type B is poorly defined.
AIMS To investigate the impact of HDV status on morbidity and mortality in cirrhosis type B.
PATIENTS/METHODS Retrospective cohort study of 200 Western European patients with compensated cirrhosis type B followed for a median period of 6.6 years.
RESULTS At diagnosis, 20% of patients had antibodies to HDV (anti-HDV); median age was lower in anti-HDV positive cirrhotics (34 v 48 years respectively). Kaplan-Meier five year probability of hepatocellular carcinoma (HCC) was 6, 10, and 9% in anti-HDV positive/HBeAg negative, anti-HDV negative/HBeAg negative, and anti-HDV negative/HBeAg positive cirrhotics respectively; the corresponding figures for decompensation were 22, 16, and 19% and for survival they were 92, 89, and 83% respectively. Cox regression analysis identified age, albumin concentration, γ-globulin concentration, and HDV status as significant independent prognostic variables. After adjustment for clinical and serological differences at baseline, the risk (95% confidence interval) for HCC, decompensation, and mortality was increased by a factor of 3.2 (1.0 to 10), 2.2 (0.8 to 5.7), and 2.0 (0.7 to 5.7) respectively in anti-HDV positive relative to HDV negative cirrhotic patients. The adjusted estimated five year risk for HCC was 13, 4, and 2% for anti-HDV positive/HBeAg negative, anti-HDV negative/HBeAg negative, and anti-HDV negative/HBeAg positive cirrhotics respectively; the corresponding figures for decompensation were 18, 8, and 14% and for survival 90, 95, and 93% respectively.
CONCLUSIONS HDV infection increases the risk for HCC threefold and for mortality twofold in patients with cirrhosis type B.
- Abbreviations used in this paper:
- hepatitis delta virus
- hepatitis B virus
- hepatitis B surface antigen
- hepatitis B e antigen
- enzyme linked immunosorbent assay
- hepatocellular carcinoma