Hepatitis Delta Virus Worsens the Outcome of HBV-HIV Coinfected Patients 

By Marina Nunez, MD, PhD

The effect of hepatitis D virus (HDV) infection on outcomes of patients with HBV and HIV coinfection treated with antiretroviral therapy is unclear. Investigators from Taiwan identified 26 patients with HDV/HBV/HIV coinfection between January 1995 and June 2003 (infection with HCV was an exclusion criteria in this study).

These patients were compared with 78 HBV/HIV coinfected patients matched by age, sex, baseline CD4 count and liver disease status. Virological, immunological and clinical endpoints were examined. The median observation time was of 55 months (range 2 to 116).

HDV-infected patients tended to have acquired the infections more frequently by intravenous drug use, and significantly more often have negative HBV DNA at baseline (p=0.03). The outcome of HIV infection was comparable for HDV-infected and non-HDV patients as measured by viral suppression, CD4 counts and development of AIDS-defining illnesses.

Over time, HDV-infected patients were more likely to clear HBs antigenemia (p=0.02) and less likely to develop genotypic resistance to 3TC (p=0.003). However, they have more episodes of hepatitis flares (p=0.001) and hyperbilirubinemia (p=0.04), and were more likely to develop liver cirrhosis (p=0.005) and hepatic decompensation (p=0.002). HDV-infection was also associated with higher mortality (hazard ratio of 5.55 (95% CI 1.43-21.58; p=0.01).

These data suggest that HDV infection further worsens the outcome of HBV/HIV coinfected patients, even with the use of HAART.

02/21/06

Reference
W-H Sheng and others. Clinical and virologic effect of chronic hepatitis D virus infection on patients with hepatitis B and HIV coinfection in the era of HAART. 13^th Conference on Retroviruses and Opportunistic Infections. February 5-8, 2006, Denver, CO. Abstract 838.