Case Control Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 27, 2020; 12(6): 277-287
Published online Jun 27, 2020. doi: 10.4254/wjh.v12.i6.277
Changing delta hepatitis patient profile: A single center experience in Valencia region, Spain
Helena Hernàndez-Èvole, Álvaro Briz-Redón, Marina Berenguer
Helena Hernàndez-Èvole, Marina Berenguer, Departament de Medicina, University of València, Valencia 46010, Spain
Álvaro Briz-Redón, Statistics Office, City Council of València, Valencia 46002, Spain
Marina Berenguer, Liver Transplantation and Hepatology Unit, Hospital Universitari I Politècnic La Fe, Valencia 46026, Spain
Marina Berenguer, CIBERehd, Instituto de Salud Carlos III, Madrid 28029, Spain
Marina Berenguer, ISS La Fe, Valencia 46026, Spain
Author contributions: Hernàndez-Èvole H performed the research and wrote the manuscript; Berenguer M designed the study and corrected the manuscript; Briz-Redón A was involved in the statistical analysis.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board.
Conflict-of-interest statement: Marina Berenguer has received a grant from Gilead, has been advisor for Abbvie and Intercept, and has been a speaker and/or moderator in meetings organized by Abbvie, Gilead, Intercept, Novartis and Astellas. All authors have nothing to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Marina Berenguer, MD, Professor, Liver Transplantation and Hepatology Unit, Hospital Universitari I Politècnic La Fe, Avenue Abril Martorell, 106, Valencia 46026, Spain. marina.berenguer@uv.es
Received: February 9, 2020
Peer-review started: February 9, 2020
First decision: March 18, 2020
Revised: April 7, 2020
Accepted: May 5, 2020
Article in press: May 5, 2020
Published online: June 27, 2020
Abstract
BACKGROUND

Delta hepatitis is a rare infection with an aggressive disease course. For almost three decades, however, there have been no epidemiological studies in our traditionally endemic area.

AIM

To investigate the prevalence of delta hepatitis in a sample of patients with chronic hepatitis B virus (HBV) infection followed at a Hepatology Unit in Valencia, Spain.

METHODS

Retrospective evaluation of anti-hepatitis D virus-immunoglobulin G seroprevalence among patients with chronic HBV infection (n = 605) followed at a reference Hepatology Unit in Spain.

RESULTS

The prevalence of anti-hepatitis D virus-immunoglobulin G among HBV-infected patients was 11.5%: Male (63%) and median age of 52 years. The majority were born in Spain (67%) and primarily infected through intravenous drug use. However, a significant percent (24.5%), particularly those diagnosed in more recent years, were migrants presumably nosocomially infected. Comorbidities such as diabetes (8.5%), obesity/overweight (55%), and alcohol consumption (34%) were frequent. A high proportion of patients developed liver complications such as cirrhosis (77%), liver decompensation (81%), hepatocellular carcinoma (HCC) (16.5%), or required liver transplantation (LT) (59.5%). Diabetes was associated with progression to cirrhosis, LT, and death. Male sex, increasing age, and alcohol were associated with LT and HCC. Compared to HBV mono-infected patients, delta individuals developed cirrhosis and liver decompensation more frequently, with no differences in HCC rates.

CONCLUSION

Patients infected in the 1980’s were mostly locals infected through intravenous drug use, whereas those diagnosed recently are frequently non-Spanish natives from endemic areas. Regardless of their origin, patients are predominantly male with significant comorbidities, which potentially play a major role in disease progression. We confirm a high rate of subsequent liver complications.

Keywords: Viral hepatitis, Delta hepatitis, Cirrhosis, Liver transplantation, Immigration, Valencia

Core tip: Our study shows that there has been a change in the delta hepatitis virus-infected patient profile in our unit. Most patients infected in the 1980s, due to intravenous drug abuse, have progressed to cirrhosis and/or hepatocellular carcinoma and therefore still represent a significant burden on our Hepatology Unit. However, our main concern is with newly diagnosed patients, as there is a clear delay in the diagnosis of infection and cirrhosis. In addition, follow-up in their home countries has been poor. Most of them come from Eastern Europe and prior medical intervention was the main route of infection. We must also take into account the presence of comorbidities, e.g., metabolic syndrome and alcohol intake, which may contribute to the aggressive progression of the disease. Therefore, we must devote our efforts to controlling these aspects and finding an effective treatment, given the poor results offered by pegylated-α-interferon.