Background
Hepatitis B virus (HBV) is a major global health challenge with approximately 250–350 mil- lion chronically infected individuals. An improved understanding of the demographic fea- tures and outcomes of chronic HBV infection and hepatitis D virus (HDV) infection in low- endemic areas may improve prevention, early identification and management both at indi- vidual and community levels. Here, we retrospectively analyzed the demographic and clini- cal characteristics, treatment rates and outcomes of adult patients with chronic HBV infection with or without HDV coinfection examined at Lausanne University Hospital, Swit- zerland over a 10-year period.
Methods
We analyzed the medical records of all adult patients with chronic HBV and HDV infection examined in our center between 2007 and 2016. Liver-related outcome was defined as the occurrence of cirrhosis, hepatocellular carcinoma, liver transplantation or liver-related death. Analyses were performed using logistic regression and results were reported as odds ratio (OR) and 95% confidence interval (CI).
Results
Of 672 consecutive patients, 421 (62.6%) were male, median age was 36 years (interquar- tile range, 28–46 years), and 233 (34.7%) were of African origin. The prevalence of HDV coinfection was 7.1% and the proportion of anti-HDV-positive patients with detectable HDV RNA was 70.0%. In multivariate analysis, HDV coinfection was the strongest predictor for liver-related outcome (OR 6.06, 95% CI 2.93–12.54, p<0.001), followed by HBeAg positivity (OR 2.47, 95% CI 1.30–4.69, p = 0.006), age (OR per 10-year increase 2.03, 95% CI 1.63–2.52, accuracy of the multivariate model was high (receiver operator characteristic area under the curve 0.81).
Conclusion
This retrospective study underscores the importance of migration in the epidemiology of chronic hepatitis B in low-endemic areas. HDV coinfection, HBeAg positivity and age pre- dicted liver-related outcomes while female sex had a protective effect.