In the Journals

HIV, hepatitis B virus coinfection increased hepatitis D incidence

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March 25, 2014

The prevalence of recent hepatitis D virus infection among patients with HIV/hepatitis B virus coinfection has increased significantly since 1992, according to recent study findings.

Additionally, recent hepatitis D virus (HDV) seroconversion was found to be associated with hepatitis flares and syphilis.

In the retrospective cohort study, researchers evaluated 375 patients coinfected with HIV and hepatitis B virus (HBV) who were seen at the National Taiwan University Hospital between 1992 and 2012. Blood samples were taken to detect the presence of anti-HDV immunoglobulin G to establish the approximate HDV incidence between 1992 and 2012. In addition, the investigators determined the plasma HDV and HBV viral loads and HBV surface antigen (HBsAg) concentrations for the HDV seroconverters.

A nested case-control study also was conducted, with the goal of further understanding the process of HDV seroconversion. This study included case patients who had recently seroconverted, as well as control patients with a similar follow-up period but no HDV seroconversion. The groups were matched for age, sex, HIV transmission risk, baseline T-cell count (± 20 cells/mcL) and plasma HIV RNA load (± 0.5 log10 copies/mL). A phylogenetic evaluation was conducted using HDV sequences from HDV seroconverters (n=12) and patients who were HDV-positive at baseline (n=16.)

The researchers found that during the entire 1,762.4 person-years of follow-up, the overall incidence rate of HDV seroconversion was 9.07 per 1,000 person-years of follow-up. During the period from 1992 to 2001, this rate was 0 per 1,000 person-years of follow-up; 3.81 from 2002 to 2006; and 13.26 from 2007 to 2012 (P<.05). There was a correlation found between recent HDV infection and elevated aminotransferase and bilirubin levels, as well as elevated rapid plasma reagin titers. Two of the 12 patients who had HDV detected in the blood tested positive for genotype 2, and 10 patients were positive for genotype 4. There was a sustained elevation in HBsAg levels despite a substantial decrease in plasma HBV DNA load with antiretroviral therapy consisting of combination lamivudine (Epivir, ViiV Healthcare) and/or tenofovir (Viread, Gilead).

“The prevalence of HBV infection has been on the decrease in the developed world where HBV vaccination program is implemented,” the researchers wrote. “However, HDV seroprevalence has not shown a similar decline in these developed countries, which may be related to ongoing risk behaviors that facilitate HDV transmission among the persons at risk and immigration of persons from regions endemic for HBV and HDV infections.”

Disclosure: The researchers report no relevant financial disclosures.