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Fernbach S, Mair NK, Abela IA, Groen K, Kuratli R, Lork M, Thorball CW, Bernasconi E, Filippidis P, Leuzinger K, Notter J, Rauch A, Hirsch HH, Huber M, Günthard HF, Fellay J, Kouyos RD, Hale BG. Loss of tolerance precedes triggering and lifelong persistence of pathogenic type I interferon autoantibodies. J Exp Med 2024; 221:e20240365. [PMID: 39017930 PMCID: PMC11253716 DOI: 10.1084/jem.20240365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/10/2024] [Accepted: 06/21/2024] [Indexed: 07/18/2024] Open
Abstract
Autoantibodies neutralizing type I interferons (IFN-Is) can underlie infection severity. Here, we trace the development of these autoantibodies at high-resolution using longitudinal samples from 1,876 well-treated individuals living with HIV over a 35-year period. Similar to general populations, ∼1.9% of individuals acquired anti-IFN-I autoantibodies as they aged (median onset ∼63 years). Once detected, anti-IFN-I autoantibodies persisted lifelong, and titers increased over decades. Individuals developed distinct neutralizing and non-neutralizing autoantibody repertoires at discrete times that selectively targeted combinations of IFNα, IFNβ, and IFNω. Emergence of neutralizing anti-IFNα autoantibodies correlated with reduced baseline IFN-stimulated gene levels and was associated with subsequent susceptibility to severe COVID-19 several years later. Retrospective measurements revealed enrichment of pre-existing autoreactivity against other autoantigens in individuals who later developed anti-IFN-I autoantibodies, and there was evidence for prior viral infections or increased IFN at the time of anti-IFN-I autoantibody triggering. These analyses suggest that age-related loss of self-tolerance prior to IFN-I immune-triggering poses a risk of developing lifelong functional IFN-I deficiency.
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Affiliation(s)
- Sonja Fernbach
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Nina K. Mair
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Irene A. Abela
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kevin Groen
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Roger Kuratli
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Marie Lork
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Christian W. Thorball
- Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Ente Ospedaliero Cantonale Lugano, University of Geneva and University of Southern Switzerland, Lugano, Switzerland
| | - Paraskevas Filippidis
- Department of Medicine, Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Julia Notter
- Division of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Andri Rauch
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hans H. Hirsch
- Department of Biomedicine, Transplantation and Clinical Virology, University of Basel, Basel, Switzerland
| | - Michael Huber
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Huldrych F. Günthard
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jacques Fellay
- Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Roger D. Kouyos
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Benjamin G. Hale
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
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Khattak A, Vongsavath T, Haque L, Narwan A, Gish RG. The Forgotten Virus, Hepatitis D: A Review of Epidemiology, Diagnosis, and Current Treatment Strategies. J Clin Exp Hepatol 2024; 14:101395. [PMID: 38617106 PMCID: PMC11015125 DOI: 10.1016/j.jceh.2024.101395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/05/2024] [Indexed: 04/16/2024] Open
Abstract
Hepatitis D virus (HDV) is an RNA subvirus that infects patients with co-existing hepatitis B virus (HBV) infections. HDV burden is estimated to be approximately 15-20 million people worldwide. Despite HDV severity, screening for HDV remains inadequate. HDV screening would benefit from a revamped approach that automatically reflexes testing when individuals are diagnosed with HBV if HBsAg-positive, to total anti-HDV, and then to quantitative HDV-RNA polymerase chain reaction (PCR) rather than only testing those at high risk sequentially. There are no current treatments in the United States that are Food and Drug Administration (FDA)-approved for the treatment of HDV; however, bulevirtide (BLV) is approved in the European Union conditionally and is under review with the United States FDA. Current treatment strategies in many countries are centered on the use of pegylated-interferon-alfa-2a (PEG-IFNa-2a). There are other therapies in development globally that have shown promise, including BLV, pegylated-interferon-lambda (PEG-IFN-lambda), and lonafarnib (LNF). LNF has shown substantial response in the LOWR trials. BLV is a well-tolerated drug, but it is not finite therapy and has shown significant on-treatment responses in the MYR clinical trials, and the FDA cited concerns with the manufacturing and patient preparation of the drug that have delayed approval. The PDUFA date for BLV in the United States is mid-2024. Current studies with both BLV and LNF are limited in providing sustained virological response (SVR); future trials will need to demonstrate more substantial SVR with possible triple combination trials as options.
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Affiliation(s)
- Adam Khattak
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
| | - Tahne Vongsavath
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
| | - Lubaba Haque
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
| | - Amrit Narwan
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
| | - Robert G. Gish
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
- Hepatitis B Foundation, Doylestown, PA, USA
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Dargaud Y, Levrero M, Bailly F, Lienhart A, Zoulim F. Liver health in hemophilia in the era of gene therapy. Thromb Res 2024; 240:109064. [PMID: 38878740 DOI: 10.1016/j.thromres.2024.109064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/25/2024] [Accepted: 06/12/2024] [Indexed: 07/07/2024]
Abstract
Gene therapy for hemophilia is a groundbreaking treatment approach with promising results and potential to reduce the burden of the disease. However, uncertainties remain, particularly regarding the liver side effects of AAV gene therapy, which are more common in hemophilia A. Unlike some other diseases, such as spinal muscular atrophy, where the target cell for gene therapy is different from the one affected by side effects, hemophilia gene therapy operates within the same cellular domain-the hepatocyte. This overlap is challenging and requires a targeted strategy to mitigate the risks associated with liver injury, which often requires temporary immunosuppressive therapy. A comprehensive approach is essential to increase the efficacy of gene therapy and reduce the likelihood of hepatocyte damage. Key components of this strategy include a thorough pre-gene therapy assessment of liver health, careful post-gene therapy liver monitoring, and prompt therapeutic intervention for loss of transgene expression and liver injury. Collaboration between hematologists and hepatologists is essential to ensure a well-coordinated management plan for patients undergoing hemophilia gene therapy. This review addresses the critical aspect of hepatic comorbidities in patients with hemophilia, emphasizing the need to identify and address these issues prior to initiating gene therapy. It examines the known mechanisms of liver damage and emphasizes the importance of liver monitoring after gene therapy. In addition, the review draws insights from experiences with other AAV-based gene therapies, providing valuable lessons that can guide hemophilia centers in effectively managing liver damage associated with hemophilia gene therapy.
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Affiliation(s)
- Yesim Dargaud
- French Reference Center for Hemophilia, Clinical Haemostasis Unit, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France; Universite Claude Bernard Lyon 1 (UCLB), Lyon, France; The Lyon Hepatology Institute EVEREST, France.
| | - Massimo Levrero
- Universite Claude Bernard Lyon 1 (UCLB), Lyon, France; Department of Hepatology, Hopital Croix-Rousse, Hospices Civils de Lyon, INSERM, Lyon, France; INSERM Unit 1052, Lyon, France; The Lyon Hepatology Institute EVEREST, France
| | - François Bailly
- Department of Hepatology, Hopital Croix-Rousse, Hospices Civils de Lyon, INSERM, Lyon, France; INSERM Unit 1052, Lyon, France; The Lyon Hepatology Institute EVEREST, France
| | - Anne Lienhart
- French Reference Center for Hemophilia, Clinical Haemostasis Unit, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Fabien Zoulim
- Universite Claude Bernard Lyon 1 (UCLB), Lyon, France; Department of Hepatology, Hopital Croix-Rousse, Hospices Civils de Lyon, INSERM, Lyon, France; INSERM Unit 1052, Lyon, France; The Lyon Hepatology Institute EVEREST, France
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4
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Buti M, Wedemeyer H, Aleman S, Chulanov V, Morozov V, Sagalova O, Stepanova T, Gish RG, Lloyd A, Kaushik AM, Suri V, Manuilov D, Osinusi AO, Flaherty JF, Lampertico P. Patient-reported outcomes in chronic hepatitis delta: An exploratory analysis of the Phase III MYR301 trial of bulevirtide. J Hepatol 2024:S0168-8278(24)02337-7. [PMID: 39009085 DOI: 10.1016/j.jhep.2024.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND & AIMS Once-daily treatment of chronic hepatitis delta (CHD) with bulevirtide is well tolerated and associated with significant reductions in HDV RNA in the blood and in biochemical liver disease activity. This study explored the effects of 48-week bulevirtide treatment on health-related quality of life (HRQoL) in patients with CHD. METHODS In an open-label, randomised, Phase 3 trial, 150 patients with CHD and compensated liver disease were stratified by liver cirrhosis status and randomised 1:1:1 to no treatment (control), bulevirtide 2 mg/day, or bulevirtide 10 mg/day for 48 weeks. HRQoL was evaluated by the following patient-reported outcome (PRO) instruments at baseline, 24 weeks, and 48 weeks: EQ-5D-3L, Hepatitis Quality of Life Questionnaire (HQLQ), and Fatigue Severity Scale (FSS). RESULTS Patient characteristics and HRQoL scores were balanced at baseline between the treatment (2 mg, n = 49; 10 mg, n = 50) and control (n = 51) groups. Patients receiving 2-mg bulevirtide reported significant improvements compared with controls on the HQLQ domains of role physical, hepatitis-specific limitations, and hepatitis-specific health distress. Numerically higher scores for general health, hepatitis-specific limitations, and hepatitis-specific health distress domains were reported by patients with cirrhosis who received bulevirtide vs control. FSS scores remained stable across treatment groups throughout. At week 48, patients in the 2-mg group showed greater mean improvement from baseline in health status compared with controls on the EQ-5D-3L visual analogue scale. CONCLUSION PROs indicate that 48-week treatment with bulevirtide monotherapy may improve aspects of HRQoL in patients with CHD. IMPACT AND IMPLICATIONS Bulevirtide 2 mg is the only approved treatment for patients with chronic hepatitis delta (CHD) in the EU. Patients with CHD have worse quality of life scores than those with chronic hepatitis B. Bulevirtide treatment for 48 weeks reduced HDV RNA and alanine aminotransferase levels and was well tolerated among patients with CHD. For the first time, this study shows that patients who received bulevirtide therapy for 48 weeks reported improvements in physical and hepatitis-related quality of life domains compared to those who did not receive therapy (control group). CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier, NCT03852719.
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Affiliation(s)
- Maria Buti
- Liver Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBER-EHD) del Instituto Carlos III, Barcelona, Spain.
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Soo Aleman
- Department of Infectious Diseases, Karolinska Universitetssjukhuset, Karolinska lnstitutet, Stockholm, Sweden
| | - Vladimir Chulanov
- Department of Infectious Diseases, Sechenov University, Moscow, Russian Federation
| | | | - Olga Sagalova
- South Ural State Medical University, Chelyabinsk, Russian Federation
| | | | - Robert G Gish
- Robert G. Gish Consultants, LLC, San Diego, CA, USA; Hepatitis B Foundation, Doylestown, PA, USA
| | | | | | | | | | | | | | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; CRC "A. M. and A. Migliavacca" Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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5
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Asselah T, Chulanov V, Lampertico P, Wedemeyer H, Streinu-Cercel A, Pântea V, Lazar S, Placinta G, Gherlan GS, Bogomolov P, Stepanova T, Morozov V, Syutkin V, Sagalova O, Manuilov D, Mercier RC, Ye L, Da BL, Chee G, Lau AH, Osinusi A, Bourliere M, Ratziu V, Pol S, Hilleret MN, Zoulim F. Bulevirtide Combined with Pegylated Interferon for Chronic Hepatitis D. N Engl J Med 2024; 391:133-143. [PMID: 38842520 DOI: 10.1056/nejmoa2314134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND In a phase 3 trial, bulevirtide monotherapy led to a virologic response in patients with chronic hepatitis D. Pegylated interferon (peginterferon) alfa-2a is recommended by guidelines as an off-label treatment for this disease. The role of combination therapy with bulevirtide and peginterferon alfa-2a, particularly with regard to finite treatment, is unclear. METHODS In this phase 2b, open-label trial, we randomly assigned patients to receive peginterferon alfa-2a alone (180 μg per week) for 48 weeks; bulevirtide at a daily dose of 2 mg or 10 mg plus peginterferon alfa-2a (180 μg per week) for 48 weeks, followed by the same daily dose of bulevirtide for 48 weeks; or bulevirtide at a daily dose of 10 mg alone for 96 weeks. All the patients were followed for 48 weeks after the end of treatment. The primary end point was an undetectable level of hepatitis D virus (HDV) RNA at 24 weeks after the end of treatment. The primary comparison was between the 10-mg bulevirtide plus peginterferon alfa-2a group and the 10-mg bulevirtide monotherapy group. RESULTS A total of 24 patients received peginterferon alfa-2a alone, 50 received 2 mg and 50 received 10 mg of bulevirtide plus peginterferon alfa-2a, and 50 received 10 mg of bulevirtide monotherapy. At 24 weeks after the end of treatment, HDV RNA was undetectable in 17% of the patients in the peginterferon alfa-2a group, in 32% of those in the 2-mg bulevirtide plus peginterferon alfa-2a group, in 46% of those in the 10-mg bulevirtide plus peginterferon alfa-2a group, and in 12% of those in the 10-mg bulevirtide group. For the primary comparison, the between-group difference was 34 percentage points (95% confidence interval, 15 to 50; P<0.001). At 48 weeks after the end of treatment, HDV RNA was undetectable in 25% of the patients in the peginterferon alfa-2a group, in 26% of those in the 2-mg bulevirtide plus peginterferon alfa-2a group, in 46% of those in the 10-mg bulevirtide plus peginterferon alfa-2a group, and in 12% of those in the 10-mg bulevirtide group. The most frequent adverse events were leukopenia, neutropenia, and thrombocytopenia. The majority of adverse events were of grade 1 or 2 in severity. CONCLUSIONS The combination of 10-mg bulevirtide plus peginterferon alfa-2a was superior to bulevirtide monotherapy with regard to an undetectable HDV RNA level at 24 weeks after the end of treatment. (Funded by Gilead Sciences; MYR 204 ClinicalTrials.gov number, NCT03852433.).
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Affiliation(s)
- Tarik Asselah
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Vladimir Chulanov
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Pietro Lampertico
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Heiner Wedemeyer
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Adrian Streinu-Cercel
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Victor Pântea
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Stefan Lazar
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Gheorghe Placinta
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - George S Gherlan
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Pavel Bogomolov
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Tatyana Stepanova
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Viacheslav Morozov
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Vladimir Syutkin
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Olga Sagalova
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Dmitry Manuilov
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Renee-Claude Mercier
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Lei Ye
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Ben L Da
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Grace Chee
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Audrey H Lau
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Anu Osinusi
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Marc Bourliere
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Vlad Ratziu
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Stanislas Pol
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Marie-Noëlle Hilleret
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
| | - Fabien Zoulim
- From Université de Paris-Cité, Department of Hepatology, Hôpital Beaujon Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, Pitié-Salpétrière, INSERM Unité Mixte de Recherche S 1138, Centre de Recherche des Cordeliers (V.R.), and Hôpital Cochin, AP-HP, Université Paris-Cité (S.P.), Paris, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble (M.-N.H.), and Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM Unité 1052, Lyon Hepatology Institute, Lyon (F.Z.) - all in France; the Infectious Diseases Department, Sechenov University (V.C.), M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), the Clinic of Modern Medicine (T.S.), and the Research Institute of Emergency Medicine n.a. N.V. Sklifosovsky (V.S.), Moscow, Medical Company "Hepatolog," Samara (V.M.), and South Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; the Department of Pathophysiology and Transplantation, Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, and CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan - both in Milan (P.L.); Klinik für Gastroenterologie, Hepatologie, und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany (H.W.); Matei Bals National Institute of Infectious Diseases (A.S.-C.), Carol Davila University of Medicine and Pharmacy (A.S.-C., G.S.G.), and Dr. Victor Babes Foundation (G.S.G.), Infectious and Tropical Diseases Hospital (S.L.) - all in Bucharest, Romania; Infectious Clinical Hospital "T. Ciorba" (V.P.) and State University of Medicine and Pharmacy "Nicolae Testemitanu" (G.P.), Chisinau, Moldova; and Gilead Sciences, Foster City, CA (D.M., R.-C.M., L.Y., B.L.D., G.C., A.H.L., A.O.)
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Zoulim F, Chen PJ, Dandri M, Kennedy P, Seeger C. Hepatitis B Virus DNA integration: Implications for diagnostics, therapy, and outcome. J Hepatol 2024:S0168-8278(24)02343-2. [PMID: 38971531 DOI: 10.1016/j.jhep.2024.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/26/2024] [Accepted: 06/29/2024] [Indexed: 07/08/2024]
Abstract
HBV DNA integration originally recognized as a non-functional byproduct of the HBV life cycle has now been accepted as a significant contributor to HBV pathogenesis and HDV persistence. Integrated HBV DNA is derived from linear genomic DNA present in virus particles or produced from aberrantly processed relaxed circular genomic DNA following an infection, and can drive expression of HBsAg and HBx. DNA integration events accumulate over the course of viral infection ranging from a few percent during early phases to nearly 100 percent of infected cells after prolonged chronic infection. HBV DNA integration events have primarily been investigated in the context of HCC development where they can activate known oncogenes and other growth promoting genes, cause chromosomal instability and presumably epigenetic alterations promoting tumor growth. More recent evidence suggests that HBsAg expression from integrated DNA might contribute to HBV pathogenesis by attenuating the immune response. Integrated DNA provides a source for envelope proteins required for HDV replication and hence represents a means for HDV persistence. Because integrated DNA is responsible for persistence of HBsAg in the absence of viral replication it impacts established criteria for the resolution of HBV infection which relies on HBsAg as a diagnostic marker. Integrated HBV DNA has been useful in assessing the turnover of infected hepatocytes which occurs during all phases of chronic hepatitis B including the initial phase of infection historically termed immune tolerant. HBV DNA integration was also shown to impact the development of novel therapies targeting viral RNAs.
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Affiliation(s)
- Fabien Zoulim
- Université Claude Bernard Lyon 1, Hospices Civils de Lyon, INSERM, Lyon Hepatology Institute, Lyon, France.
| | - Pei-Jer Chen
- Hepatitis Research Center and Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Maura Dandri
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems Partner Site
| | - Patrick Kennedy
- Liver Centre, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
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7
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Ricco G, Brunetto MR. Reply to: "Increase in HDV replication during steroid therapy - potential implications for testing and treatment strategies". J Hepatol 2024; 81:e51-e53. [PMID: 38582305 DOI: 10.1016/j.jhep.2024.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/08/2024]
Affiliation(s)
- Gabriele Ricco
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Maurizia R Brunetto
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56127, Pisa, Italy; Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
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8
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Wong RJ, Brosgart C, Wong SS, Feld J, Glenn J, Hamid S, Cohen C, Zovich B, Ward J, Wedemeyer H, Yurdaydin C, Gish R. Estimating the prevalence of hepatitis delta virus infection among adults in the United States: A meta-analysis. Liver Int 2024; 44:1715-1734. [PMID: 38563728 DOI: 10.1111/liv.15921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/05/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND AND AIMS Suboptimal awareness and low rates of hepatitis delta virus (HDV) testing contribute to underdiagnosis and gaps in accurate estimates of U.S. HDV prevalence. We aim to provide an updated assessment of HDV prevalence in the U.S. using a comprehensive literature review and meta-analysis approach. METHODS A comprehensive literature review of articles reporting HBsAg seroprevalence and anti-HDV prevalence was conducted to calculate country-specific rates and pooled prevalence of CHB and HDV using meta-analyses. Country-specific CHB and HDV rate estimates were combined with number of foreign-born (FB) persons in the U.S. in 2022 from U.S. Census Bureau to estimate total numbers of FB with CHB and HDV, respectively. These estimates were further combined with updated estimates of U.S.-born persons with CHB and HDV to yield the total number of persons with CHB and HDV. RESULTS In 2022, we estimated 1.971 million (M) (95% CI 1.547-2.508) persons with CHB; 1.547 M (95% CI 1.264-1.831) were FB and 0.424 M (95% CI: 0.282-0.678) were U.S.-born. The weighted average HDV prevalence among FB persons in the U.S. was 4.20% (64 938 [95% CI 33055-97 392] persons), among whom 45% emigrated from Asia, 25% from Africa, and 14% from Europe. When combined with updated estimates of U.S.-born persons with HDV, we estimate 75 005 (95% CI: 42187-108 393) persons with HDV in the U.S. CONCLUSIONS Including both FB and U.S.-born persons, we estimated that 1.971 M and 75 005 persons were living with CHB and HDV, respectively, in the U.S. in 2022.
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Affiliation(s)
- Robert J Wong
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA
- Gastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Carol Brosgart
- Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Steven S Wong
- S Wong Consulting, LLC, Mountain View, California, USA
| | - Jordan Feld
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - Jeffrey Glenn
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA
- Gastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Saeed Hamid
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Chari Cohen
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
| | | | - John Ward
- Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, Georgia, USA
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Cihan Yurdaydin
- Department of Gastroenterology and Hepatology, Koç University School of Medicine, Istanbul, Turkey
| | - Robert Gish
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
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9
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Giannini EG, Pasta A, Pieri G, Plaz Torres MC, Marseglia M, Pelizzaro F, Sangiovanni A, Cabibbo G, Ghittoni G, Di Marco M, Foschi FG, Guarino M, Biasini E, Saitta C, Campani C, Svegliati-Baroni G, Gasbarrini A, Brunetto MR, Magalotti D, Azzaroli F, Mega A, Sacco R, Nardone G, Sacerdoti D, Masotto A, Vidili G, Bucci L, Vitale A, Trevisani F. Characteristics and outcome of anti-hepatitis D virus positive patients with hepatocellular carcinoma. Liver Int 2024; 44:1588-1599. [PMID: 38426262 DOI: 10.1111/liv.15855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/20/2023] [Accepted: 01/07/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND & AIMS Chronic hepatitis D virus (HDV) often leads to end-stage liver disease and hepatocellular carcinoma (HCC). Comprehensive data pertaining to large populations with HDV and HCC are missing, therefore we sought to assess the characteristics, management, and outcome of these patients, comparing them to patients with hepatitis B virus (HBV) infection. METHODS We analysed the Italian Liver Cancer database focusing on patients with positivity for HBV surface antigen and anti-HDV antibodies (HBV/HDV, n = 107) and patients with HBV infection alone (n = 588). Clinical and oncological characteristics, treatment, and survival were compared in the two groups. RESULTS Patients with HBV/HDV had worse liver function [Model for End-stage Liver Disease score: 11 vs. 9, p < .0001; Child-Turcotte-Pugh score: 7 vs. 5, p < .0001] than patients with HBV. HCC was more frequently diagnosed during surveillance (72.9% vs. 52.4%, p = .0002), and the oncological stage was more frequently Milan-in (67.3% vs. 52.7%, p = .005) in patients with HBV/HDV. Liver transplantation was more frequently performed in HBV/HDV than in HBV patients (36.4% vs. 9.5%), while the opposite was observed for resection (8.4% vs. 20.1%, p < .0001), and in a competing risk analysis, HBV/HDV patients had a higher probability of receiving transplantation, independently of liver function and oncological stage. A trend towards longer survival was observed in patients with HBV/HDV (50.4 vs. 44.4 months, p = .106). CONCLUSIONS In patients with HBV/HDV, HCC is diagnosed more frequently during surveillance, resulting in a less advanced cancer stage in patients with more deranged liver function than HBV alone. Patients with HBV/HDV have a heightened benefit from liver transplantation, positively influencing survival.
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Affiliation(s)
- Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Pasta
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giulia Pieri
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Corina Plaz Torres
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mariarosaria Marseglia
- Division of Internal Medicine, Hepatobiliary Diseases and Immunoallergology, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Filippo Pelizzaro
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padua, Padua, Italy
| | - Angelo Sangiovanni
- Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale maggiore Policlinico and C.R.C. "A.M. & A. Migliavacca Center for Liver Disease", Milan, Italy
| | - Giuseppe Cabibbo
- Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, Palermo, Italy
| | | | | | | | - Maria Guarino
- Department of Clinical Medicine and Surgery, Diseases of the Liver and Biliary System Unit, University of Naples "Federico II", Naples, Italy
| | - Elisabetta Biasini
- Infectious Diseases and Hepatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Carlo Saitta
- Department of Clinical and Experimental Medicine, Clinical and Molecular Hepatology Unit, University of Messina, Messina, Italy
| | - Claudia Campani
- Department of Experimental and Clinical Medicine, Internal Medicine and Hepatology Unit, University of Florence, Florence, Italy
| | | | - Antonio Gasbarrini
- Liver Unit, CEMAD - Centro Malattie dell'Apparato Digerente, Medicina Interna e Gastroenterologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - Maurizia Rossana Brunetto
- Department of Clinical and Experimental Medicine, Hepatology and Liver Physiopathology Laboratory, University Hospital of Pisa, Pisa, Italy
| | - Donatella Magalotti
- Division of Internal Medicine, Neurovascular and Hepatometabolic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Azzaroli
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Mega
- Gastroenterology Unit, Bolzano Regional Hospital, Bolzano, Italy
| | - Rodolfo Sacco
- Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, Foggia, Italy
| | - Gerardo Nardone
- Department of Clinical Medicine and Surgery, Hepato-Gastroenterology Unit, University of Naples "Federico II", Naples, Italy
| | - David Sacerdoti
- Liver Unit, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Alberto Masotto
- Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Gianpaolo Vidili
- Department of Medical, Surgical and Experimental Sciences, Clinica Medica Unit, University of Sassari, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Laura Bucci
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-related Diseases, University of Bologna, Bologna, Italy
| | - Alessandro Vitale
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Franco Trevisani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-related Diseases, University of Bologna, Bologna, Italy
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10
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Degasperi E, Anolli MP, Lampertico P. Advances in hepatitis delta research: emerging insights and future directions. Sex Transm Infect 2024:sextrans-2023-056098. [PMID: 38914473 DOI: 10.1136/sextrans-2023-056098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/31/2024] [Indexed: 06/26/2024] Open
Abstract
OBJECTIVES Hepatitis delta virus (HDV) is a defective virus needing the envelope provided by hepatitis B virus (HBV) in order to enter liver cells and propagate. Chronic HDV infection is considered the most severe viral hepatitis, resulting in accelerated fibrosis progression until cirrhosis and its complications (hepatocellular carcinoma, liver decompensation) compared with HBV mono-infected patients. Off-label treatment with interferon has represented the only treatment option in the last 40 years, resulting in suboptimal virological response rates and being limited by safety issues especially in patients with advanced cirrhosis. Recently, the first HBV-HDV entry inhibitor Bulevirtide (BLV) has been approved by the European Medicines Agency (EMA) for treatment of chronic compensated HDV. METHODS This review summarises most recent updates on HDV epidemiology, diagnosis and treatment, with a special focus both on clinical trials and real-life studies about BLV. An overview on new HDV compounds under development is also provided. RESULTS BLV, the HBV-HDV entry inhibitor, has shown promising safety and efficacy data in clinical trials and in real-life studies, also in patients with advanced cirrhosis and portal hypertension. However, according to EMA label treatment is currently intended long-term until clinical benefit and predictors of responses are still undefined. The potential combination with PegIFNα seems to increase virological and clinical responses. New compounds are under development or in pipeline for treatment of HDV. CONCLUSION After more than 40 years since HDV discovery, new treatment options are currently available to provide efficient strategies for chronic hepatitis Delta.
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Affiliation(s)
- Elisabetta Degasperi
- Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy
| | - Maria Paola Anolli
- Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy
| | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy
- CRC 'A. M. and A. Migliavacca' Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy
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11
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Toniutto P, Falleti E, Cmet S, Cussigh A, Degasperi E, Anolli MP, Sambarino D, Facchetti F, Borghi M, Perbellini R, Monico S, Lampertico P. Sodium taurocholate cotransporting polypeptide (NTCP) polymorphisms may influence HDV RNA load and early response to bulevirtide. J Hepatol 2024:S0168-8278(24)02319-5. [PMID: 38901675 DOI: 10.1016/j.jhep.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 06/03/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND & AIMS Genetic polymorphisms in the sodium taurocholate cotransporting peptide (NTCP encoded by SLC10A1) have been described, but their role in untreated and treated patients with chronic hepatitis delta (CHD) remains unknown. Virological response (VR) to the NTCP inhibitor bulevirtide (BLV) was achieved at week 48 by >70% of patients with CHD, but nearly 15% experienced virological non-response (VNR) or partial response (PR). This study aimed to evaluate whether NTCP genetic polymorphisms affect baseline HDV RNA load and response to BLV in patients with CHD. METHODS BLV-untreated and -treated patients were enrolled in a retrospective cross-sectional and longitudinal study. Clinical and virological characteristics were collected at baseline and up to 96 weeks in the BLV-treated patients. NTCP genetic polymorphisms were identified by Sanger sequencing. RESULTS Of the six NTCP polymorphisms studied in 209 untreated patients with CHD, carriers of the rs17556915 TT/CC (n = 142) compared to CT (n = 67) genotype presented with higher median HDV RNA levels (5.39 vs. 4.75 log10 IU/ml, p = 0.004). Of 209 patients receiving BLV monotherapy at 2 mg/day, 76 were evaluated at week 24 and 40 up to week 96. Higher mean baseline HDV RNA levels were confirmed in TT/CC (n = 43) compared to CT (n = 33) carriers (5.38 vs. 4.72 log10 IU/ml, p = 0.010). Although 24-week VR was comparable between TT/CC and CT carriers (25/43 vs. 17/33, p = 0.565), the former group presented VNR more often than PR (9/11 vs. 9/23, p = 0.02) at week 24. 7/9 TT/CC genotype carriers remained VNR at week 48 of BLV treatment. CONCLUSIONS The NTCP rs17556915 C>T genetic polymorphisms may influence baseline HDV RNA load both in BLV-untreated and -treated patients with CHD and may contribute to identifying patients with different early virological responses to BLV. IMPACT AND IMPLICATIONS Although several sodium taurocholate cotransporting polypeptide (NTCP) genetic polymorphisms have been described, no data are available on their potential role in modifying HDV RNA load or treatment response to bulevirtide (BLV) in patients with chronic hepatitis delta (CHD). In this study, we demonstrated that patients with CHD, either treated or untreated, carrying NTCP rs17556915 TT/CC, presented higher baseline HDV RNA levels compared to those with the CT genotype. Higher HDV RNA levels in TT/CC carriers compared to CT carriers were also confirmed in patients with CHD treated with BLV monotherapy up to 96 weeks. Furthermore, carriers of TT/CC, compared to CT genotype, more frequently showed viral non-response (VNR) than partial response (PR) at week 24 of BLV treatment, and 7/9 TT/CC genotype carriers remained VNR at week 48 of BLV treatment. This is the first study demonstrating a potential role of NTCP genetic polymorphisms in influencing HDV viral load and early virological response to BLV monotherapy. Since no direct HDV resistance to BLV has been described so far, if confirmed in larger studies, the genetic polymorphisms in NTCP may help identify patients with different patterns of early virological response to BLV.
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Affiliation(s)
| | - Edmondo Falleti
- Hepatology and Liver Transplantation Unit, University of Udine, Italy
| | - Sara Cmet
- Clinical Pathology, Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy
| | - Annarosa Cussigh
- Clinical Pathology, Azienda Ospedaliero Universitaria Friuli Centrale, Udine, Italy
| | - Elisabetta Degasperi
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Paola Anolli
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dana Sambarino
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Floriana Facchetti
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Borghi
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Perbellini
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Monico
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; CRC "A. M. and A. Migliavacca" Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; D-SOLVE consortium, an EU Horizon Europe funded project (No 101057917)
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12
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Sandmann L, Bremer B, Deterding K, Port K, Gey B, Früchtel C, Reinhardt A, Lachmann I, Cornberg M, Kefalakes H, Maasoumy B, Wedemeyer H. Letter to the Editor: The WHO HDV RNA international standard does not reflect variability of real-world samples. Hepatology 2024:01515467-990000000-00917. [PMID: 38889083 DOI: 10.1097/hep.0000000000000975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 05/21/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Lisa Sandmann
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
- D-SOLVE consortium, an EU Horizon Europe-funded project (no. 101057917)
- Excellence Cluster RESIST, Hannover Medical School, Hannover, Germany
| | - Birgit Bremer
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Katja Deterding
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Kerstin Port
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | | | | | | | | | - Markus Cornberg
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
- D-SOLVE consortium, an EU Horizon Europe-funded project (no. 101057917)
- German Center for Infection Research (DZIF), Hannover/Braunschweig, Germany
- Centre for Individualised Infection Medicine, Helmholtz Centre for Infection Research/Hannover Medical School, Hannover, Germany
| | - Helenie Kefalakes
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
- D-SOLVE consortium, an EU Horizon Europe-funded project (no. 101057917)
- Excellence Cluster RESIST, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), Hannover/Braunschweig, Germany
| | - Benjamin Maasoumy
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), Hannover/Braunschweig, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
- D-SOLVE consortium, an EU Horizon Europe-funded project (no. 101057917)
- Excellence Cluster RESIST, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), Hannover/Braunschweig, Germany
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13
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Lai JCT, Wong GLH, Wong VWS, Yip TCF. Unmet need in screening for hepatitis D virus: Time to take action. J Hepatol 2024; 80:e277-e278. [PMID: 38110005 DOI: 10.1016/j.jhep.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/03/2023] [Accepted: 12/11/2023] [Indexed: 12/20/2023]
Affiliation(s)
- Jimmy Che-To Lai
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Grace Lai-Hung Wong
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Vincent Wai-Sun Wong
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Terry Cheuk-Fung Yip
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China.
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14
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Allweiss L, Volmari A, Suri V, Wallin JJ, Flaherty JF, Manuilov D, Downie B, Lütgehetmann M, Bockmann JH, Urban S, Wedemeyer H, Dandri M. Blocking viral entry with bulevirtide reduces the number of HDV-infected hepatocytes in human liver biopsies. J Hepatol 2024; 80:882-891. [PMID: 38340811 DOI: 10.1016/j.jhep.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND & AIMS Bulevirtide (BLV) is a first-in-class entry inhibitor and the only approved treatment for patients chronically infected with HDV in Europe. We aimed to investigate the efficacy of BLV treatment in paired liver biopsies obtained at baseline and after 24 or 48 weeks of treatment. METHODS We performed a combined analysis of 126 paired liver biopsies derived from three clinical trials. In the phase II clinical trial MYR202, patients with chronic hepatitis D were randomised to receive 24 weeks of BLV at 2 mg, 5 mg or 10 mg/day. Patients in MYR203 (phase II) and MYR301 (phase III) received 48 weeks of BLV at 2 mg or 10 mg/day. Tenofovir disoproxil fumarate monotherapy or delayed treatment served as comparators. Virological parameters and infection-related host genes were assessed by qPCR and immunohistochemistry. RESULTS At week 24, median intrahepatic HDV RNA decline from baseline was 0.9Log10 with 2 mg (n = 7), 1.1Log10 with 5 mg (n = 5) and 1.4 Log10 with 10 mg (n = 7) of BLV. At week 48, median reductions were 2.2Log10 with 2 mg (n = 27) and 2.7Log10 with 10 mg (n = 37) of BLV, while HDV RNA levels did not change in the comparator arms. Notably, a drastic decline in the number of hepatitis delta antigen-positive hepatocytes and a concomitant decrease in transcriptional levels of inflammatory chemokines and interferon-stimulated genes was determined in all BLV-treatment arms. Despite the abundance of HBsAg-positive hepatocytes, replication and covalently closed circular DNA levels of the helper virus HBV were low and remained unaffected by BLV treatment. CONCLUSION Blocking viral entry diminishes signs of liver inflammation and promotes a strong reduction of HDV infection within the liver, thus suggesting that some patients may achieve HDV cure with long-term treatment. IMPACT AND IMPLICATIONS Chronic infection with HDV causes the most severe form of viral hepatitis, affecting approximately 12 million people worldwide. The entry inhibitor bulevirtide (BLV) is the only recently approved anti-HDV drug, which has proven efficacious and safe in clinical trials and real-word data. Here, we investigated paired liver biopsies at baseline and after 24 or 48 weeks of treatment from three clinical trials to understand the effect of the drug on viral and host parameters in the liver, the site of viral replication. We found that BLV treatment strongly reduces the number of HDV-infected cells and signs of liver inflammation. This data implies that blocking viral entry ameliorates liver inflammation and that prolonged treatment regimens might lead to HDV cure in some patients. This concept will guide the further development of therapeutic strategies and combination treatments for patients with CHD. CLINICAL TRIAL NUMBERS NCT03546621, NCT02888106, NCT03852719.
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Affiliation(s)
- Lena Allweiss
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research (DZIF), Hannover, Heidelberg and Hamburg-Lübeck-Borstel-Riems Partner Sites, Germany
| | - Annika Volmari
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | | | | | - Marc Lütgehetmann
- Department of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research (DZIF), Hannover, Heidelberg and Hamburg-Lübeck-Borstel-Riems Partner Sites, Germany
| | - Jan-Hendrik Bockmann
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research (DZIF), Hannover, Heidelberg and Hamburg-Lübeck-Borstel-Riems Partner Sites, Germany
| | - Stephan Urban
- Department of Infectious Diseases, Molecular Virology, University Hospital Heidelberg, Heidelberg, Germany; German Center for Infection Research (DZIF), Hannover, Heidelberg and Hamburg-Lübeck-Borstel-Riems Partner Sites, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; German Center for Infection Research (DZIF), Hannover, Heidelberg and Hamburg-Lübeck-Borstel-Riems Partner Sites, Germany
| | - Maura Dandri
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research (DZIF), Hannover, Heidelberg and Hamburg-Lübeck-Borstel-Riems Partner Sites, Germany.
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15
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Wong RJ, Hirode G, Feld J, Wong SS, Brosgart C, Glenn J, Hamid S, Cohen C, Zovich B, Ward J, Wedemeyer H, Yurdaydin C, Gish R. An updated assessment of hepatitis delta prevalence among adults in Canada: A meta-analysis. J Viral Hepat 2024; 31:324-341. [PMID: 38619214 DOI: 10.1111/jvh.13939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 04/16/2024]
Abstract
Foreign-born (FB) persons represent a large proportion of adults with chronic hepatitis B (CHB) in Canada due to higher prevalence rates in countries of birth for FB persons. Suboptimal awareness and low rates of hepatitis delta virus (HDV) testing contribute to underdiagnosis and gaps in accurate estimates of Canada HDV prevalence. We aim to provide an assessment of CHB and HDV prevalence in Canada using a comprehensive literature review and meta-analysis. A comprehensive literature review of articles reporting HBsAg seroprevalence and anti-HDV prevalence was conducted to calculate country-specific rates and pooled prevalence of CHB and HDV using meta-analyses. Country-specific CHB and HDV rate estimates were combined with number of FB persons in Canada in 2021 from Statistics Canada to estimate total numbers of FB with CHB and HDV, respectively. These estimates were combined with estimates of Canada-born persons with CHB and HDV to yield the total number of persons with CHB and HDV. In 2021, we estimated 0.550 million (M) (95% CI 0.488-0.615) persons with CHB; 0.344 M (95% CI 0.288-0.401) were FB and 0.206 M (95% CI: 0.200-0.214) were Canada-born. The weighted average HDV prevalence among FB persons in Canada was 5.19% (17,848 [95% CI 9611-26,052] persons), among whom 50% emigrated from Asia and 31% from Africa. When combined with estimates of Canada-born persons with HDV, we estimate 35,059 (95% CI: 18,744-52,083) persons with HDV in Canada. In conclusion, we estimate 0.550 M and 35,059 persons living with CHB and HDV, respectively, in Canada in 2021.
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Affiliation(s)
- Robert J Wong
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA
- Gastroenterology Section Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Grishma Hirode
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - Jordan Feld
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - Steven S Wong
- S Wong Consulting, LLC, Mountain View, California, USA
| | - Carol Brosgart
- Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Jeffrey Glenn
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA
- Gastroenterology Section Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Saeed Hamid
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Chari Cohen
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
| | | | - John Ward
- Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, Georgia, USA
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Cihan Yurdaydin
- Department of Gastroenterology and Hepatology, Koç University School of Medicine, Istanbul, Turkey
| | - Robert Gish
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
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Castro e Silva ED, Roca TP, Passos-Silva AM, Borzacov LMP, Silva Oliveira AAD, Queiroz JADS, Salcedo JMV, Vieira D. Clinical profile and parameters of patients monoinfected with HBV and infected with HDV in Western Amazon. Heliyon 2024; 10:e31065. [PMID: 38803893 PMCID: PMC11128886 DOI: 10.1016/j.heliyon.2024.e31065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024] Open
Abstract
Background Hepatitis Delta represents a greater risk in the progression of advanced liver disease and HCC compared with HBV. The exact mechanism that determines the spontaneous clearance of delta virus or its progression to cirrhosis remains unknown. Therefore, this study aimed to analyze the clinical profile of HBV and HBV/HDV individuals in the Western Amazon. Methods The study was carried out at the Specialized Outpatient Clinic for Viral Hepatitis belonging to the Centro de Pesquisa em Medicina Tropical de Rondônia/CEPEM. 100 individuals were included, stratified into two groups: 50 with hepatitis B virus and 50 with hepatitis Delta virus. Results The overall mean age was 48 years. For the HBV and HDV groups, 66 % (33/50) and 54 % (27/50) were men and 56 % (28/50) and 58 % (29/50) were on antiviral treatment, respectively. Patients with detectable HDV-RNA demonstrated high levels of ALT and AST compared to individuals with undetectable HDV-RNA. Comparative analysis between HBV carriers and infected with HDV shows significant differences in terms of age, HBV-DNA levels, albumin, hepatomegaly and splenomegaly. Conclusion Several markers were important for differentiating HBV and HDV infections. HDV-RNA detectable showed significant changes in biomarkers compared to undetectable patients, suggesting a possible worse prognostic effect in this group.
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Affiliation(s)
- Eugênia de Castro e Silva
- Laboratório de Virologia Molecular, Fundação Oswaldo Cruz Rondônia - FIOCRUZ/RO, Porto Velho, RO, Brazil
- Programa de Pós-Graduação Em Medicina Tropical, Instituto Oswaldo Cruz/IOC, FIOCRUZ, RJ, Brazil
- Instituto Nacional de Ciência e Tecnologia de Epidemiologia da Amazônia Ocidental – INCT-EpiAmO, Porto Velho, RO, Brazil
- Departamento de Medicina, Universidade Federal de Rondônia – UNIR, Porto Velho, RO, Brazil
- Centro de Pesquisa Em Medicina Tropical – CEPEM, Porto Velho, RO, Brazil
| | - Tárcio Peixoto Roca
- Laboratório de Virologia Molecular, Fundação Oswaldo Cruz Rondônia - FIOCRUZ/RO, Porto Velho, RO, Brazil
- Programa de Pós-Graduação Em Medicina Tropical, Instituto Oswaldo Cruz/IOC, FIOCRUZ, RJ, Brazil
- Instituto Nacional de Ciência e Tecnologia de Epidemiologia da Amazônia Ocidental – INCT-EpiAmO, Porto Velho, RO, Brazil
- Laboratório de Hepatites Virais, Instituto Oswaldo Cruz/IOC, FIOCRUZ, RJ, Brazil
| | - Ana Maísa Passos-Silva
- Laboratório de Virologia Molecular, Fundação Oswaldo Cruz Rondônia - FIOCRUZ/RO, Porto Velho, RO, Brazil
- Instituto Nacional de Ciência e Tecnologia de Epidemiologia da Amazônia Ocidental – INCT-EpiAmO, Porto Velho, RO, Brazil
- Programa de Pós-Graduação Em Biologia Experimental, Universidade Federal de Rondônia e Fundação Oswaldo Cruz Rondônia – UNIR/FIOCRUZ-RO, Porto Velho, RO, Brazil
| | | | - Adrhyan Araújo da Silva Oliveira
- Laboratório de Virologia Molecular, Fundação Oswaldo Cruz Rondônia - FIOCRUZ/RO, Porto Velho, RO, Brazil
- Instituto Nacional de Ciência e Tecnologia de Epidemiologia da Amazônia Ocidental – INCT-EpiAmO, Porto Velho, RO, Brazil
| | - Jackson Alves da Silva Queiroz
- Laboratório de Virologia Molecular, Fundação Oswaldo Cruz Rondônia - FIOCRUZ/RO, Porto Velho, RO, Brazil
- Instituto Nacional de Ciência e Tecnologia de Epidemiologia da Amazônia Ocidental – INCT-EpiAmO, Porto Velho, RO, Brazil
- Programa de Pós-Graduação Em Biologia Experimental, Universidade Federal de Rondônia e Fundação Oswaldo Cruz Rondônia – UNIR/FIOCRUZ-RO, Porto Velho, RO, Brazil
| | - Juan Miguel Villalobos Salcedo
- Departamento de Medicina, Universidade Federal de Rondônia – UNIR, Porto Velho, RO, Brazil
- Centro de Pesquisa Em Medicina Tropical – CEPEM, Porto Velho, RO, Brazil
| | - Deusilene Vieira
- Laboratório de Virologia Molecular, Fundação Oswaldo Cruz Rondônia - FIOCRUZ/RO, Porto Velho, RO, Brazil
- Instituto Nacional de Ciência e Tecnologia de Epidemiologia da Amazônia Ocidental – INCT-EpiAmO, Porto Velho, RO, Brazil
- Programa de Pós-Graduação Em Biologia Experimental, Universidade Federal de Rondônia e Fundação Oswaldo Cruz Rondônia – UNIR/FIOCRUZ-RO, Porto Velho, RO, Brazil
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17
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Kondili LA, Brancaccio G, Tosti ME, Coco B, Quaranta MG, Messina V, Ciancio A, Morisco F, Cossiga V, Claar E, Rosato V, Ciarallo M, Cacciola I, Ponziani FR, Cerrito L, Coppola R, Longobardi F, Biliotti E, Rianda A, Barbaro F, Coppola N, Stanzione M, Barchiesi F, Fagiuoli S, Viganò M, Massari M, Russo FP, Ferrarese A, Laccabue D, Di Marco V, Blanc P, Marrone A, Morsica G, Federico A, Ieluzzi D, Rocco A, Foschi FG, Soria A, Maida I, Chessa L, Milella M, Rosselli Del Turco E, Madonia S, Chemello L, Gentile I, Toniutto P, Bassetti M, Surace L, Baiocchi L, Pellicelli A, De Santis A, Puoti M, Degasperi E, Niro GA, Zignego AL, Craxi A, Raimondo G, Santantonio TA, Brunetto MR, Gaeta GB. A holistic evaluation of patients with chronic Hepatitis D virus (HDV) infection enrolled in the Italian PITER-B and delta cohort. Int J Infect Dis 2024; 146:107115. [PMID: 38801968 DOI: 10.1016/j.ijid.2024.107115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND AND AIMS We aimed to characterize the epidemiologic and comorbidities profiles of patients with chronic Hepatitis D (CHD) followed in clinical practice in Italy and explored their interferon (IFN) eligibility. METHODS This was a cross-sectional study of the PITER cohort consisting of consecutive HBsAg-positive patients from 59 centers over the period 2019-2023. Multivariable analysis was performed by logistic regression model. RESULTS Of 5492 HBsAg-positive enrolled patients, 4152 (75.6%) were screened for HDV, 422 (10.2%) were anti-HDV positive. Compared with HBsAg mono-infected, anti-HDV positive patients were more often younger, non-Italians, with a history of drug use, had elevated alanine transaminase (ALT), cirrhosis, or hepatocellular carcinoma (HCC). Compared with Italians, anti-HDV positive non-Italians were younger (42.2% age ≤ 40 years vs. 2.1%; P < 0.001), more often females (males 43.0% vs. 68.6%; P < 0.001) with less frequent cirrhosis and HCC. HDV-RNA was detected in 63.2% of anti-HDV-positive patients, who were more likely to have elevated ALT, cirrhosis, and HCC. Extrahepatic comorbidities were present in 47.4% of anti-HDV positive patients and could affect the eligibility of IFN-containing therapies in at least 53.0% of patients in care. CONCLUSIONS CHD affects young, foreign-born patients and older Italians, of whom two-thirds had cirrhosis or HCC. Comorbidities were frequent in both Italians and non-Italians and impacted eligibility for IFN.
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Affiliation(s)
- Loreta A Kondili
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy; UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy.
| | - Giuseppina Brancaccio
- Department of Molecular Medicine, Infectious Diseases, University of Padua, Padua, Italy
| | | | - Barbara Coco
- Hepatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Vincenzo Messina
- Department of Infectious Diseases, Sant'Anna Hospital, Caserta, Italy
| | - Alessia Ciancio
- Gastroenterology Unit, Città della Salute e della Scienza of Turin, University Hospital, Turin, Italy
| | - Filomena Morisco
- Liver and Biliary System Unit, Department of Clinical Medicine and Surgery, University of Naples, Naples, Italy
| | - Valentina Cossiga
- Liver and Biliary System Unit, Department of Clinical Medicine and Surgery, University of Naples, Naples, Italy
| | | | | | | | - Irene Cacciola
- Department of Internal Medicine, University Hospital of Messina, Messina, Italy
| | - Francesca Romana Ponziani
- Liver Unit, Digestive Disease Center, CEMAD Division of Internal Medicine and Gastroenterology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lucia Cerrito
- Liver Unit, Digestive Disease Center, CEMAD Division of Internal Medicine and Gastroenterology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberta Coppola
- Department of Hepatology, Gragnano Hospital, Gragnano (NA), Italy
| | | | - Elisa Biliotti
- National Institute for Infectious Diseases, Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Alessia Rianda
- National Institute for Infectious Diseases, Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Francesco Barbaro
- Department of Medicine, Infectious Diseases Unit, University Hospital of Padua, Padua, Italy
| | - Nicola Coppola
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Stanzione
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Barchiesi
- Clinical Infectious Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Stefano Fagiuoli
- Department of Medicine, University of Milan Bicocca & Gastroenterology Hepatology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Mauro Viganò
- Department of Medicine, University of Milan Bicocca & Gastroenterology Hepatology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Marco Massari
- Malattie Infettive, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Paolo Russo
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padua, Padua, Italy
| | - Alberto Ferrarese
- Gastroenterology Unit, University Hospital Borgo Trento, Verona, Italy
| | - Diletta Laccabue
- Department of Medicine and Surgery, Università degli Studi di Parma, Parma, Italy
| | - Vito Di Marco
- Biomedical Department of Internal and Specialistic Medicine University of Palermo, Unit of Gastroenterology and Hepatology, Palermo, Italy
| | - Pierluigi Blanc
- Infectious Disease Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Aldo Marrone
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giulia Morsica
- Unit of Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Federico
- Hepato-Gastroenterology Division, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Alba Rocco
- Department of Clinical Medicine and Surgery, Hepato-Gastroenterology Unit, University of Naples Federico II, Naples, Italy
| | | | - Alessandro Soria
- Clinic of Infectious Diseases, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Ivana Maida
- Infectious and Tropical Diseases Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Luchino Chessa
- Liver Unit, University Hospital, Monserrato, Cagliari, Italy
| | - Michele Milella
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Elena Rosselli Del Turco
- Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Salvatore Madonia
- Department of Internal Medicine Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Liliana Chemello
- Department of Medicine-DIMED, Padua University, University Hospital, Padua, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Pierluigi Toniutto
- Hepatology and Liver Transplant Unit, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Matteo Bassetti
- Clinica Malattie Infettive, Università degli Studi di Genova, Policlinico S. Martino IRCCS, Genova, Italy
| | - Lorenzo Surace
- Ambulatorio di Epatologia e Infettivologia, Azienda Sanitaria Provinciale CZ-Distretto del Lametino, Lamezia Terme (CZ), Italy
| | | | | | - Adriano De Santis
- Department of Internal Medicine, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Massimo Puoti
- Infectious Disease Unit, Niguarda Hospital, Milan, Italy
| | | | - Grazia Anna Niro
- Division of Gastroenterology and Endoscopy, Fondazione IRCCS 'Casa Sollievo della Sofferenza', San Giovanni Rotondo, Foggia, Italy
| | - Anna Linda Zignego
- Department of Experimental and Clinical Medicine, Interdepartmental Centre MASVE, University of Florence, Italy
| | - Antonio Craxi
- Gastroenterology and Hepatology Unit, PROMISE, University of Palermo, Palermo, Italy
| | - Giovanni Raimondo
- Department of Internal Medicine, University Hospital of Messina, Messina, Italy
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Le Guillou-Guillemette H, Pivert A, ElBara A, Vall M, Sang CNW, Veillon P, Ducancelle A, Bollahi MA, Mohamed MS, Lunel-Fabiani F. Prevalence, clinical and virological characteristics and short-term prognosis of hepatitis delta infection among patients with HIV/HBV in Nouakchott, Mauritania. J Viral Hepat 2024. [PMID: 38771311 DOI: 10.1111/jvh.13950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024]
Abstract
Patients living with HIV infection (PLWH) are at risk of acquiring HBV and HDV. The present study aimed to determine the prevalence and characteristics of HIV-HDV-HBV tri-infection in comparison with HIV-HBV coinfection and to estimate severities and outcomes of associated liver diseases in Mauritanian PLWH. Two-hundred-ninety-two consecutive HBsAg-positive PLWH were included (mean age: 37 years). Clinical data were recorded. Anti-HDV antibodies, HBV and HDV viral loads (VLs) and genotype were determined. APRI, FIB-4 and FibroScan were performed to evaluate the severity of liver disease. The anti-HDV antibodies prevalence was 37% and HDV RNA was positive in 40.7% of patients. Genetic diversities were found with HDV genotype 1 (93%) and HBV genotypes D (42.5%) and E (38%). The HBV VL was detectable in 108 patients at inclusion, and mutations associated with HBV resistance were found in 20. For almost all variables studied, including FIB-4 and APRI scores, no significant differences were found between anti-HDV-Ab positive or negative patients. FibroScan examination, which was performed in 110 patients at end-of-follow-up showed higher, but NS values, in HDV positive patients. After a mean follow-up of 24.55 ± 8.01 months (n = 217 patients), a highly significant worsening of APRI and FIB-4 scores was found. Moreover, patients with HDV showed more severe liver disease progression despite an efficient therapy. In a substantial Mauritanian cohort of relatively young PLWH, we found high HDV prevalence and worsening liver disease. In high-risk countries, screening for HDV and providing appropriate follow-up and treatments are warranted in PLWH.
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Affiliation(s)
- Hélène Le Guillou-Guillemette
- Virology Department, Angers University Hospital, Angers, France
- HIFIH Laboratory EA 3859, Angers University, Angers, France
| | - Adeline Pivert
- Virology Department, Angers University Hospital, Angers, France
- HIFIH Laboratory EA 3859, Angers University, Angers, France
| | | | | | | | - Pascal Veillon
- Virology Department, Angers University Hospital, Angers, France
| | - Alexandra Ducancelle
- Virology Department, Angers University Hospital, Angers, France
- HIFIH Laboratory EA 3859, Angers University, Angers, France
| | | | | | - Françoise Lunel-Fabiani
- Virology Department, Angers University Hospital, Angers, France
- HIFIH Laboratory EA 3859, Angers University, Angers, France
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Wedemeyer H, Aleman S, Brunetto M, Blank A, Andreone P, Bogomolov P, Chulanov V, Mamonova N, Geyvandova N, Morozov V, Sagalova O, Stepanova T, Berger A, Ciesek S, Manuilov D, Mercier RC, Da BL, Chee GM, Li M, Flaherty JF, Lau AH, Osinusi A, Schulze Zur Wiesch J, Cornberg M, Zeuzem S, Lampertico P. Bulevirtide monotherapy in patients with chronic HDV: Efficacy and safety results through week 96 from a phase III randomized trial. J Hepatol 2024:S0168-8278(24)00333-7. [PMID: 38734383 DOI: 10.1016/j.jhep.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/15/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND & AIMS Bulevirtide (BLV), a first-in-class entry inhibitor, is approved in Europe for the treatment of chronic hepatitis delta (CHD). BLV monotherapy was superior to delayed treatment at week (W) 48, the primary efficacy endpoint, in the MYR301 study (NCT03852719). Here, we assessed if continued BLV therapy until W96 would improve virologic and biochemical response rates, particularly among patients who did not achieve virologic response at W24. METHODS In this ongoing, open-label, randomized phase III study, patients with CHD (N = 150) were randomized (1:1:1) to treatment with BLV 2 mg/day (n = 49) or 10 mg/day (n = 50), each for 144 weeks, or to delayed treatment for 48 weeks followed by BLV 10 mg/day for 96 weeks (n = 51). Combined response was defined as undetectable hepatitis delta virus (HDV) RNA or a decrease in HDV RNA by ≥2 log10 IU/ml from baseline and alanine aminotransferase (ALT) normalization. Other endpoints included virologic response, ALT normalization, and change in HDV RNA. RESULTS Of 150 patients, 143 (95%) completed 96 weeks of the study. Efficacy responses were maintained and/or improved between W48 and W96, with similar combined, virologic, and biochemical response rates between BLV 2 and 10 mg. Of the patients with a suboptimal early virologic response at W24, 43% of non-responders and 82% of partial responders achieved virologic response at W96. Biochemical improvement often occurred independently of virologic response. Adverse events were mostly mild, with no serious adverse events related to BLV. CONCLUSIONS Virologic and biochemical responses were maintained and/or increased with longer term BLV therapy, including in those with suboptimal early virologic response. BLV monotherapy for CHD was safe and well tolerated through W96. IMPACT AND IMPLICATIONS In July 2023, bulevirtide was fully approved for the treatment of chronic hepatitis delta (CHD) in Europe based on clinical study results from up to 48 weeks of treatment. Understanding the efficacy and safety of bulevirtide over the longer term is important for healthcare providers. In this analysis, we demonstrate that bulevirtide monotherapy for 96 weeks in patients with CHD was associated with continued improvements in combined, virologic, and biochemical responses as well as liver stiffness from week 48 at both the 2 mg and 10 mg doses. Patients with suboptimal virologic responses to bulevirtide at week 24 also benefited from continued therapy, with the majority achieving virologic response or biochemical improvement by week 96. CLINICAL TRIALS GOV IDENTIFIER NCT03852719.
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Affiliation(s)
- Heiner Wedemeyer
- Medizinische Hochschule Hannover, Klinik für Gastroenterologie, Hepatologie, Infektiologie und Endokrinologie, Hannover, Germany.
| | - Soo Aleman
- Karolinska University Hospital/Karolinska Institute, Department of Infectious Diseases, Stockholm, Sweden
| | - Maurizia Brunetto
- University Hospital of Pisa, Hepatology Unit, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, Pisa, Italy; University of Pisa, Department of Clinical and Experimental Medicine, Pisa, Italy
| | - Antje Blank
- Heidelberg University Medical Faculty, Heidelberg University Hospital, Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg, Germany
| | - Pietro Andreone
- University of Modena and Reggio Emilia, Internal Medicine, Baggiovara Hospital, Modena, Italy
| | - Pavel Bogomolov
- State Budgetary Institution of Health Care of Moscow Region, Moscow Regional Research Clinical Institute Named After M.F. Vladimirsky, Moscow, Russian Federation
| | - Vladimir Chulanov
- FSBI National Research Medical Center for Phthisiopulmonology and Infectious Diseases of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Nina Mamonova
- FSBI National Research Medical Center for Phthisiopulmonology and Infectious Diseases of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | | | | | - Olga Sagalova
- Federal State-Funded Institution of Higher Education, South Ural State Medical University of Ministry of Health of the Russian Federation, Chelyabinsk, Russian Federation
| | | | - Annemarie Berger
- Institute for Medical Virology, German Centre for Infection Research, External Partner Site Frankfurt, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Sandra Ciesek
- Institute for Medical Virology, German Centre for Infection Research, External Partner Site Frankfurt, University Hospital, Goethe University, Frankfurt am Main, Germany
| | | | | | - Ben L Da
- Gilead Sciences, Foster City, CA, United States
| | | | - Mingyang Li
- Gilead Sciences, Foster City, CA, United States
| | | | | | - Anu Osinusi
- Gilead Sciences, Foster City, CA, United States
| | - Julian Schulze Zur Wiesch
- Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik Studienambulanz Hepatologie, Hamburg, Germany
| | - Markus Cornberg
- Medizinische Hochschule Hannover, Klinik für Gastroenterologie, Hepatologie, Infektiologie und Endokrinologie, Hannover, Germany
| | - Stefan Zeuzem
- University Hospital Frankfurt, Department of Medicine, Frankfurt am Main, Germany
| | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; CRC A. M. and A. Migliavacca Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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20
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Stockdale AJ, Degasperi E. HDV RNA and liver disease progression: What do we know? Hepatology 2024; 79:983-985. [PMID: 38156968 DOI: 10.1097/hep.0000000000000663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Alexander J Stockdale
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Malawi-Liverpool-Wellcome Trust Research Programme, Blantyre, Malawi
| | - Elisabetta Degasperi
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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21
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Gish RG, Wong RJ, Di Tanna GL, Kaushik A, Kim C, Smith NJ, Kennedy PT. Association of hepatitis delta virus with liver morbidity and mortality: A systematic literature review and meta-analysis. Hepatology 2024; 79:1129-1140. [PMID: 37870278 PMCID: PMC11019996 DOI: 10.1097/hep.0000000000000642] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/26/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND AND AIMS Studies have suggested that patients with chronic hepatitis B, either co- or superinfected, have more aggressive liver disease progression than those with the HDV. This systematic literature review and meta-analysis examined whether HDV RNA status is associated with increased risk of advanced liver disease events in patients who are HBsAg and HDV antibody positive. APPROACH AND RESULTS A total of 12 publications were included. Relative rates of progression to advanced liver disease event for HDV RNA+/detectable versus HDV RNA-/undetectable were extracted for analysis. Reported OR and HRs with 95% CI were pooled using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. The presence of HDV RNA+ was associated with an increased risk of any advanced liver disease event [random effect (95% CI): risk ratio: 1.48 (0.93, 2.33); HR: 2.62 (1.55, 4.44)]. When compared to the patients with HDV RNA- status, HDV RNA+ was associated with a significantly higher risk of progressing to compensated cirrhosis [risk ratio: 1.74 (1.24, 2.45)] decompensated cirrhosis [HR: 3.82 (1.60, 9.10)], HCC [HR: 2.97 (1.87, 4.70)], liver transplantation [HR: 7.07 (1.61, 30.99)], and liver-related mortality [HR: 3.78 (2.18, 6.56)]. CONCLUSIONS The patients with HDV RNA+ status have a significantly greater risk of liver disease progression than the patients who are HDV RNA-. These findings highlight the need for improved HDV screening and linkage to treatment to reduce the risk of liver-related morbidity and mortality.
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Affiliation(s)
- Robert G. Gish
- University of Nevada, Reno School of Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, USA
| | - Robert J. Wong
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare System, Stanford University School of Medicine, Palo Alto, California, USA
| | - Gian Luca Di Tanna
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland
| | - Ankita Kaushik
- Gilead Sciences Inc., Global Value and Access, Foster City, California, USA
| | - Chong Kim
- Gilead Sciences Inc., Global Value and Access, Foster City, California, USA
| | | | - Patrick T.F. Kennedy
- Barts Liver Centre, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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22
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John BV, Amoli MM, Evon DM, Wong R, Dahman B. Hepatitis delta testing trends in a US national cohort: An analysis of patient and provider-level predictive factors. Hepatol Commun 2024; 8:e0401. [PMID: 38619425 PMCID: PMC11019823 DOI: 10.1097/hc9.0000000000000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/29/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND The low prevalence of HDV infection in the United States could be attributed to insufficient testing rate, which can result in an underestimation of the true burden of HDV. The primary objective of this study is to quantify the prevalence of and factors associated with HDV antibody (anti-HDV) or RNA testing, among participants with positive HBsAg in the Veterans Health Administration (VHA). METHODS We conducted a retrospective cohort study of participants who tested positive for HBsAg between January 2000 and December 2022 within the VHA. We identified those who were tested for HDV, and patient and provider-level factors associated with HDV testing. RESULTS Of 41,658 participants with positive HBsAg who had follow-up, 4438 (10.7%) were tested at least once for HDV, of which 135 (3.0%) were positive. Participants in the Northeast (adjusted odds ratio [aOR]: 1.30, 95% CI: 1.17-1.44, p<0.001), and receiving hepatology care (aOR: 1.38, 95% CI: 1.24-1.54, p<0.001) were more likely, while those in the Midwest (aOR: 0.69, 95% CI: 0.60-0.79, p<0.001), under the care of a primary care provider (aOR: 0.61, 95% CI: 0.50-0.74, p<0.001), Blacks (aOR: 0.85, 95% CI: 0.77-0.94, p=0.001), participants who were HCV antibody-positive (aOR: 0.89, 95% CI: 0.81-0.99, p=0.03), and participants who were HIV-positive (aOR: 0.80, 95% CI: 0.71-0.90, p<0.001) were less likely to be tested for HDV. CONCLUSIONS HDV screening rates in the VHA remain low overall. Participants who are Black, living in the Midwest, patients who are HIV-positive, and patients who are HCV-positive are less likely to be tested for HDV. These results suggest that risk-based screening strategies are ineffective in the VHA and highlight the need for refining testing strategies to increase HDV screening rates.
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Affiliation(s)
- Binu V. John
- Department of Medicine, Division of Gastroenterology and Hepatology, Miami VA Medical System, Miami, Florida, USA
- Division of Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Donna M. Evon
- Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Robert Wong
- Division of Gastroenterology and Hepatology, Palo Alto VA Health System, Alto, California, USA
- Division of Gastroenterology, Stanford University, Palo Alto, California, USA
| | - Bassam Dahman
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, USA
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23
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Weichselbaum L, Njimi H, van den Wijngaert S, Dahma H, Nkuize M, Van Gossum M, Eisendrath P, Mulkay JP, Sersté T. A regular screening for hepatitis delta virus among chronic hepatitis B carriers improves the diagnostic of this infection and of subsequent cirrhosis development. United European Gastroenterol J 2024; 12:516-525. [PMID: 38520063 DOI: 10.1002/ueg2.12564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/26/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVE The prevalence of Hepatitis Delta Virus (HDV) is underestimated and the assessment of fibrosis is recommended for this infection. We tested the diagnostic impact of an annual screening for HDV serology in Hepatitis B Surface Antigen (HBs Ag) chronic carriers and followed the progression of fibrosis in these patients. METHODS Between January 2014 and October 2021, we annually tested all chronic HBs Ag-positive patients for HDV antibody (HDV Ab). Each HDV Ab positive patient underwent annually repeated elastometry. Patients with detectable HDV RNA levels (group 1) were compared to those with undetectable HDV RNA (group 2). RESULTS We identified 610 chronic HBs Ag-positive patients, and repeated screening for HDV Ab was performed in 534 patients. Sixty (11%) patients were HDV Ab positive at baseline and were considered as "coinfected". Seven cases of HDV superinfection were diagnosed through repeated screening. In co-infected patients, cirrhosis was initially diagnosed in 12/60 patients and developed in six patients during follow-up. HDV RNA PCR was performed in 57/67 patients and 27 had detectable levels (group 1). Cumulative incidence of cirrhosis at 7 years was 13.8% (95% CI 0-30) in group 1 and 0 (95% CI 0-0) in group 2 (p = 0.026). CONCLUSION A systematic screening for HDV in chronic HB Ag carriers revealed a high prevalence of HDV Ab. Repeated serological screening enables the diagnosis of superinfections in asymptomatic patients. Regular assessment of fibrosis using elastometry leads to the identification of incidental cirrhosis in patients with detectable HDV RNA.
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Affiliation(s)
- Laura Weichselbaum
- Department of Gastroenterology and Hepatology, CHU Saint-Pierre, Brussels, Belgium
- Department of Gastroenterology and Hepatology, CUB Erasme, Brussels, Belgium
| | - Hassane Njimi
- Department of Intensive Care, CUB Erasme, Brussels, Belgium
| | | | - Hafid Dahma
- Department of Microbiology, LHUB-ULB site Porte de Hal, Brussels, Belgium
| | - Marcel Nkuize
- Department of Gastroenterology and Hepatology, CHU Saint-Pierre, Brussels, Belgium
| | - Marc Van Gossum
- Department of Gastroenterology and Hepatology, CHU Saint-Pierre, Brussels, Belgium
| | - Pierre Eisendrath
- Department of Gastroenterology and Hepatology, CHU Saint-Pierre, Brussels, Belgium
- Department of Gastroenterology and Hepatology, CUB Erasme, Brussels, Belgium
| | - Jean-Pierre Mulkay
- Department of Gastroenterology and Hepatology, CHU Saint-Pierre, Brussels, Belgium
| | - Thomas Sersté
- Department of Gastroenterology and Hepatology, CHU Saint-Pierre, Brussels, Belgium
- Department of Gastroenterology and Hepatology, CUB Erasme, Brussels, Belgium
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24
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Iacob S, Gheorghe L, Onica M, Huiban L, Pop CS, Brisc C, Sirli R, Ester C, Brisc CM, Diaconu S, Rogoveanu I, Sandulescu L, Vuletici D, Trifan A. Prospective study of hepatitis B and D epidemiology and risk factors in Romania: A 10-year update. World J Hepatol 2024; 16:640-649. [PMID: 38689751 PMCID: PMC11056896 DOI: 10.4254/wjh.v16.i4.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/19/2024] [Accepted: 03/22/2024] [Indexed: 04/24/2024] Open
Abstract
BACKGROUND The global burden of hepatitis D virus (HDV) infection represents a major medical challenge and a public health crisis worldwide. However, there is a lack of accurate data on the epidemiology and risk factors for HDV. Hepatitis B virus (HBV) and HDV coinfection causes the most severe form of viral hepatitis, leading to a higher cumulative incidence of liver-related events compared with HBV monoinfection, including the need for liver transplantation and death. AIM To investigate the epidemiology, natural history, risk factors and clinical management of HBV and HDV coinfection in Romanian patients. METHODS This prospective study was conducted between January and July 2022 in six tertiary gastroenterology and hepatology referral centres in Romania. All consecutive adults admitted for any gastroenterology diagnosis who were HBV-positive were enrolled. Patients with acute hepatitis or incomplete data were excluded. Of the 25390 individuals who presented with any type of gastroenterology diagnosis during the study period, 963 met the inclusion criteria. Testing for anti-HDV antibodies and HDV RNA was performed for all participants. Demographic and risk factor data were collected by investigators using medical charts and patient questionnaires. All data were stored in an anonymized online database during the study. RESULTS The prevalence of HBV was 3.8%; among these patients, the prevalence of HBV/HDV coinfection was 33.1%. The median age of the study population was 54.0 years, and it consisted of 55.1% men. A higher prevalence of HBV/HDV coinfection was observed in patients 50-69 years old. Patients with HBV/HDV coinfection were significantly older than those with HBV monoinfection (P = 0.03). Multivariate multiple regression analysis identified female gender (P = 0.0006), imprisonment (P < 0.0001), older age at diagnosis (P = 0.01) and sexual contact with persons with known viral hepatitis (P = 0.0003) as significant risk factors for HDV. CONCLUSION This study shows that HDV infection among those with HBV remains endemic in Romania and updates our understanding of HDV epidemiology and associated risk factors. It emphasizes the need for systematic screening for HDV infection and collaborative initiatives for controlling and preventing HBV and HDV infection.
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Affiliation(s)
- Speranta Iacob
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Liana Gheorghe
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest 022328, Romania.
| | - Mirela Onica
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Laura Huiban
- Department of Gastroenterology, Grigore T Popa University of Medicine and Pharmacy, Iasi 700115, Romania
- Institute of Gastroenterology and Hepatology, Saint Spiridon County Hospital, Iasi 700111, Romania
| | - Corina Silvia Pop
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Gastroenterology and Medical Oncology, University Emergency Clinical Hospital, Bucharest 050098, Romania
| | - Ciprian Brisc
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410087, Romania
- Department of Gastroenterology, Emergency County Hospital, Oradea 410169, Romania
| | - Roxana Sirli
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy, Timisoara 300041, Romania
- Department of Gastroenterology and Hepatology, Timiş County Emergency Clinical Hospital "Pius Branzeu", Timisoara 300723, Romania
| | - Carmen Ester
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Cristina Mihaela Brisc
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410087, Romania
- Department of Gastroenterology, Emergency County Hospital, Oradea 410169, Romania
| | - Sorina Diaconu
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Internal Medicine II and Gastroenterology, University Emergency Clinical Hospital, Bucharest 050098, Romania
| | - Ion Rogoveanu
- Department of Gastroenterology, University of Medicine and Pharmacy, Craiova 200349, Romania
- Department of Cardiology, Emergency County Hospital, Craiova 200642, Romania
| | - Larisa Sandulescu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova 200349, Romania
- Department of Gastroenterology, Emergency County Hospital, Craiova 200642, Romania
| | - Deiana Vuletici
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy, Timisoara 300041, Romania
- Department of Gastroenterology and Hepatology, Timiş County Emergency Clinical Hospital "Pius Branzeu", Timisoara 300723, Romania
| | - Anca Trifan
- Institute of Gastroenterology and Hepatology, Saint Spiridon County Hospital, Iasi 700111, Romania
- Department of Gastroenterology, Faculty of Medicine, Grigore T Popa University of Medicine and Pharmacy, Iasi 700115, Romania
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25
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Lombardo D, Franzè MS, Caminiti G, Pollicino T. Hepatitis Delta Virus and Hepatocellular Carcinoma. Pathogens 2024; 13:362. [PMID: 38787214 PMCID: PMC11124437 DOI: 10.3390/pathogens13050362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/14/2024] [Accepted: 04/20/2024] [Indexed: 05/25/2024] Open
Abstract
The hepatitis D virus (HDV) is a compact, enveloped, circular RNA virus that relies on hepatitis B virus (HBV) envelope proteins to initiate a primary infection in hepatocytes, assemble, and secrete new virions. Globally, HDV infection affects an estimated 12 million to 72 million people, carrying a significantly elevated risk of developing cirrhosis, liver failure, and hepatocellular carcinoma (HCC) compared to an HBV mono-infection. Furthermore, HDV-associated HCC often manifests at a younger age and exhibits more aggressive characteristics. The intricate mechanisms driving the synergistic carcinogenicity of the HDV and HBV are not fully elucidated but are believed to involve chronic inflammation, immune dysregulation, and the direct oncogenic effects of the HDV. Indeed, recent data highlight that the molecular profile of HCC associated with HDV is unique and distinct from that of HBV-induced HCC. However, the question of whether the HDV is an oncogenic virus remains unanswered. In this review, we comprehensively examined several crucial aspects of the HDV, encompassing its epidemiology, molecular biology, immunology, and the associated risks of liver disease progression and HCC development.
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Affiliation(s)
| | | | | | - Teresa Pollicino
- Department of Clinical and Experimental Medicine, University Hospital of Messina, 98124 Messina, Italy; (D.L.); (M.S.F.); (G.C.)
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26
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Souleiman R, Cornberg M. [Diagnosis and treatment of viral hepatitis B and D in 2024]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:296-307. [PMID: 38418664 DOI: 10.1007/s00108-024-01671-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
Despite the availability of vaccines, hepatitis B remains a significant cause of fulminant hepatitis, liver cirrhosis and hepatocellular carcinoma worldwide. The increase in reported hepatitis B cases in Germany is attributed to factors such as immigration and the hepatitis B surface antigen (HBsAg) screening introduced in 2020 as part of health check-ups. The indication for treatment depends on various factors, including the level of hepatitis B virus (HBV) DNA and inflammatory activity. Nucleos(t)ide analogues are the preferred treatment option, but functional cure, defined as HBsAg loss, is rare. In principle, treatment with nucleos(t)ide analogues should usually be discontinued after loss of HBsAg, but can be stopped earlier under certain conditions and is currently the subject of ongoing research. Pregnancy and immunosuppression in the context of hepatitis B require special attention. In addition, a possible hepatitis D virus co-infection must always be taken into account, which is why every HBsAg-positive person should be tested for anti-HDV. Since 2020, the entry inhibitor bulevirtide has become a new treatment option alongside pegylated interferon alfa, which represents a significant advance in the treatment landscape.
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Affiliation(s)
- Roni Souleiman
- Klinik für Gastroenterologie, Hepatologie, Infektiologie, und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
- Zentrum für Individualisierte Infektionsmedizin (CiiM), Hannover, Deutschland
- Partnerstandort Hannover-Braunschweig, Deutsches Zentrum für Infektionsforschung (DZIF), Hannover, Deutschland
| | - Markus Cornberg
- Klinik für Gastroenterologie, Hepatologie, Infektiologie, und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
- Zentrum für Individualisierte Infektionsmedizin (CiiM), Hannover, Deutschland.
- Partnerstandort Hannover-Braunschweig, Deutsches Zentrum für Infektionsforschung (DZIF), Hannover, Deutschland.
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27
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Buti M, Palom A, Riveiro-Barciela M. Editorial: Liver elastography for chronic hepatitis D-the end of liver biopsy? Aliment Pharmacol Ther 2024; 59:898-899. [PMID: 38462685 DOI: 10.1111/apt.17890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
LINKED CONTENTThis article is linked to Sandmann et al paper. To view this article, visit https://doi.org/10.1111/apt.17878
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Affiliation(s)
- María Buti
- Liver Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBERehd, Instituto Carlos III, Barcelona, Spain
| | - Adriana Palom
- Liver Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBERehd, Instituto Carlos III, Barcelona, Spain
| | - Mar Riveiro-Barciela
- Liver Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBERehd, Instituto Carlos III, Barcelona, Spain
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28
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Parfut A, Tripon S, Gantner P, Chaffraix F, Laugel E, Wendling MJ, Erol F, Wiedemer C, Doffoel M, Saviano A, Royant M, Habersetzer F, Fafi-Kremer S, Velay A. Impact of anti-HDV reflex testing at HBs antigen positive discovery in a single center France: Support for primary HDV screening in France. J Clin Virol 2024; 171:105650. [PMID: 38350177 DOI: 10.1016/j.jcv.2024.105650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Hepatitis Delta virus (HDV) infection is a major cause of liver-related morbidity and mortality in patients infected with HBV, with a global HDV prevalence uncertain. In France, 2 to 5 % of HBs antigen (HBsAg) carriers present anti-HDV antibodies (anti-HDV). The EASL recommends testing for anti-HDV in all HBsAg-positive patients. Since January 2022, we have systematically carried out anti-HDV serology when a positive HBsAg is discovered (new HBsAg carriers). OBJECTIVES We evaluated the benefit of anti-HDV reflex testing after one year of practice by comparing anti-HDV and HBsAg serology data over the last six years, among the new HBsAg carriers and all the HBsAg carriers. STUDY DESIGN HBsAg and anti-HDV were screened using the Abbott Architect HBsAg quanti kit and the DIA.PRO HDVAb kit. Serological, demographic, virological, and clinical data were analyzed. RESULTS Implementing anti-HDV reflex testing leads to more than a 2-fold increase in diagnoses of HDV infection among all HBsAg carriers. If the anti-HDV positive rate remains stable among the new HBsAg carriers, a significant increase in the anti-HDV positive rate from 6.8 % to 10.3 % was observed considering all HBsAg carriers. Interestingly, the discovery of anti-HDV carriage increased from 3.9 % to 6.5 % in 2022, allowing earlier identification of HBV-HDV-infected patients and a fast referral to hepatologists for adequate clinical management and, in some cases, the introduction of bulevirtide-based therapy. CONCLUSIONS Our preliminary results at one year seem promising and evaluating the cost-effectiveness of reflex tests in real life with feedback would be helpful.
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Affiliation(s)
- Assilina Parfut
- Virology Laboratory, Strasbourg University Hospital, Strasbourg, France
| | - Simona Tripon
- Service Expert de Lutte Contre les Hépatites Virales d'Alsace (SELHVA), Pôle Hépato-Digestif, Strasbourg University Hospital, Strasbourg, France
| | - Pierre Gantner
- Unité Mixte de Recherche (UMR) S1109 Labex Transplantex, Institut National de la Santé et de la Recherche Médicale (Inserm) Fédération de Médecine Translationnelle, Strasbourg University, Strasbourg France, Department of Virology, Institut de Virologie, Strasbourg University Hospital, 3 rue Koeberlé, Strasbourg F67000, France
| | - Fréderic Chaffraix
- Service Expert de Lutte Contre les Hépatites Virales d'Alsace (SELHVA), Pôle Hépato-Digestif, Strasbourg University Hospital, Strasbourg, France
| | - Elodie Laugel
- Unité Mixte de Recherche (UMR) S1109 Labex Transplantex, Institut National de la Santé et de la Recherche Médicale (Inserm) Fédération de Médecine Translationnelle, Strasbourg University, Strasbourg France, Department of Virology, Institut de Virologie, Strasbourg University Hospital, 3 rue Koeberlé, Strasbourg F67000, France
| | | | - Furkan Erol
- Virology Laboratory, Strasbourg University Hospital, Strasbourg, France
| | - Carine Wiedemer
- Service Expert de Lutte Contre les Hépatites Virales d'Alsace (SELHVA), Pôle Hépato-Digestif, Strasbourg University Hospital, Strasbourg, France
| | - Michel Doffoel
- Service Expert de Lutte Contre les Hépatites Virales d'Alsace (SELHVA), Pôle Hépato-Digestif, Strasbourg University Hospital, Strasbourg, France
| | - Antonio Saviano
- Service Expert de Lutte Contre les Hépatites Virales d'Alsace (SELHVA), Pôle Hépato-Digestif, Strasbourg University Hospital, Strasbourg, France
| | - Maude Royant
- Service Expert de Lutte Contre les Hépatites Virales d'Alsace (SELHVA), Pôle Hépato-Digestif, Strasbourg University Hospital, Strasbourg, France
| | - François Habersetzer
- Service Hépato-Gastroentérologie et Pôle Hépato-Digestif, Hôpitaux Universitaire de Strasbourg, Université de Strasbourg, Inserm 1110, Strasbourg, Strasbourg, France
| | - Samira Fafi-Kremer
- Unité Mixte de Recherche (UMR) S1109 Labex Transplantex, Institut National de la Santé et de la Recherche Médicale (Inserm) Fédération de Médecine Translationnelle, Strasbourg University, Strasbourg France, Department of Virology, Institut de Virologie, Strasbourg University Hospital, 3 rue Koeberlé, Strasbourg F67000, France
| | - Aurélie Velay
- Unité Mixte de Recherche (UMR) S1109 Labex Transplantex, Institut National de la Santé et de la Recherche Médicale (Inserm) Fédération de Médecine Translationnelle, Strasbourg University, Strasbourg France, Department of Virology, Institut de Virologie, Strasbourg University Hospital, 3 rue Koeberlé, Strasbourg F67000, France.
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29
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Cholongitas E, Oikonomou T, Bafa K, Sinakos E, Papatheodoridis GV, Goulis I. Efficacy of Newer Nucleos(t)ide Analogs After Hepatitis B Immunoglobulin Discontinuation Against Hepatitis B and D Recurrence in Liver Transplant Recipients. Transplantation 2024:00007890-990000000-00712. [PMID: 38557857 DOI: 10.1097/tp.0000000000005027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND The use of nucleos(t)ide analogs (NAs) with a high genetic barrier to resistance, namely entecavir and tenofovir, has improved the efficacy of antiviral prophylaxis against hepatitis B virus (HBV) recurrence after liver transplantation (LT). However, the optimal duration and dosage of hepatitis B immunoglobulin (HBIG) administration, particularly in patients transplanted for HBV and hepatitis D virus (HDV) coinfection, remains controversial. METHODS We evaluated 28 patients transplanted for HBV/HDV cirrhosis. After LT, each patient received a fixed scheme of low-dose HBIG plus NA for 6 mo post-LT and then continued with long-term NA prophylaxis (entecavir: 8, tenofovir: 20 patients). RESULTS During 72 mo of follow-up, reappearance of hepatitis B surface antigen at low titers was observed in 1 (3.6%) patient at 33 mo after HBIG discontinuation, which became negative after a single dose of HBIG 1000 IU/L, whereas both serum HBV DNA and HDV RNA remained persistently undetectable and without any clinical or biochemical evidence of HBV/HDV recurrence. CONCLUSIONS We showed for the first time the efficacy of a short, fixed scheme of low-dose HBIG plus NA followed by long-term NA monoprophylaxis against HBV/HDV recurrence after LT, although careful follow-up is needed after HBIG discontinuation, whereas further larger studies are needed to confirm these findings.
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Affiliation(s)
- Evangelos Cholongitas
- First Department of Internal Medicine, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Theodora Oikonomou
- Fourth Department of Internal Medicine, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantina Bafa
- First Department of Internal Medicine, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanouil Sinakos
- Fourth Department of Internal Medicine, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George V Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko," Athens, Greece
| | - Ioannis Goulis
- Fourth Department of Internal Medicine, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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30
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Gherlan GS, Lazar SD, Culinescu A, Smadu D, Vatafu AR, Popescu CP, Florescu SA, Ceausu E, Calistru PI. Results of Response-Guided Therapy with Pegylated Interferon Alpha 2a in Chronic Hepatitis B and D. Trop Med Infect Dis 2024; 9:73. [PMID: 38668534 PMCID: PMC11054492 DOI: 10.3390/tropicalmed9040073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 04/29/2024] Open
Abstract
Pegylated interferon alpha 2a continues to be used for the treatment of chronic hepatitis D. The reported on-treatment virologic response varies between 17 and 47%, with relapses in more than 50% of these patients. No stopping rules have been defined, and the duration of the treatment is not clearly established, but it should be between 48 and 96 weeks. In total, 76 patients with compensated liver disease treated with peg-interferon according to the Romanian National protocol for the treatment of hepatitis D were retrospectively included. The duration of treatment was up to 96 weeks, with the following stopping rules: less than a 2 log HDV RNA decrease by week 24 and less than a 1 log decrease every 6 months afterwards. Six months after stopping the treatment, it can be restarted for unlimited cycles. The inclusion criteria were aged above 18, HBs Ag-positive, HDV RNA detectable, ALT above ULN and/or liver fibrosis at least F1 at liver biopsy, or Fibrotest and/or Fibroscan higher than 7 KPa and/or inflammation at least A1 at liver biopsy or Fibrotest. We monitored our patients for a total period of 4 years (including those that repeated the cycle). After the first 6 months of treatment, 27 patients (35.5%) had a greater than 2 log HDV RNA decrease, 19 of them achieving undetectable HDV RNA. Seventeen patients (22.3%) had undetectable HDV RNA 24 weeks after stopping 96 weeks of treatment, and none relapsed in the following 2 years. Of these 17 patients, 6 were cirrhotic, and 4 had F3. Undetectable HDV RNA at 24 weeks was the only parameter that predicted a long-term suppression of HDV RNA. In 49 patients, the treatment was stopped after 6 months according to protocol, but it was restarted 6 months later. Five of these patients finished a 48-week course of treatment; none achieved undetectable HDV RNA. During the first course of therapy, 45 patients had at least one moderate adverse reaction to treatment. In one patient, the treatment was stopped due to a serious adverse event (osteomyelitis). Treatment doses had to be reduced in 29 patients. The virologic response at week 24 can select the patients who will benefit from continuing the treatment from those who should be changed to another type of medication when available.
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Affiliation(s)
- George S. Gherlan
- Infectious Diseases Department, Universitatea de Medicina si Farmacie ”Carol Davila”, 050474 Bucuresti, Romania (P.I.C.)
- Infectious Diseases Department, Spitalul Clinic de Boli Infectioase si Tropicale ”Dr. Victor Babes”, 030303 Bucuresti, Romania
| | - Stefan D. Lazar
- Infectious Diseases Department, Universitatea de Medicina si Farmacie ”Carol Davila”, 050474 Bucuresti, Romania (P.I.C.)
- Infectious Diseases Department, Spitalul Clinic de Boli Infectioase si Tropicale ”Dr. Victor Babes”, 030303 Bucuresti, Romania
| | - Augustina Culinescu
- Infectious Diseases Department, Spitalul Clinic de Boli Infectioase si Tropicale ”Dr. Victor Babes”, 030303 Bucuresti, Romania
| | - Dana Smadu
- Infectious Diseases Department, Spitalul Clinic de Boli Infectioase si Tropicale ”Dr. Victor Babes”, 030303 Bucuresti, Romania
| | - Andreea R. Vatafu
- Infectious Diseases Department, Universitatea de Medicina si Farmacie ”Carol Davila”, 050474 Bucuresti, Romania (P.I.C.)
- Infectious Diseases Department, Spitalul Clinic de Boli Infectioase si Tropicale ”Dr. Victor Babes”, 030303 Bucuresti, Romania
| | - Corneliu P. Popescu
- Infectious Diseases Department, Universitatea de Medicina si Farmacie ”Carol Davila”, 050474 Bucuresti, Romania (P.I.C.)
- Infectious Diseases Department, Spitalul Clinic de Boli Infectioase si Tropicale ”Dr. Victor Babes”, 030303 Bucuresti, Romania
| | - Simin A. Florescu
- Infectious Diseases Department, Universitatea de Medicina si Farmacie ”Carol Davila”, 050474 Bucuresti, Romania (P.I.C.)
- Infectious Diseases Department, Spitalul Clinic de Boli Infectioase si Tropicale ”Dr. Victor Babes”, 030303 Bucuresti, Romania
| | - Emanoil Ceausu
- Infectious Diseases Department, Universitatea de Medicina si Farmacie ”Carol Davila”, 050474 Bucuresti, Romania (P.I.C.)
- Infectious Diseases Department, Spitalul Clinic de Boli Infectioase si Tropicale ”Dr. Victor Babes”, 030303 Bucuresti, Romania
| | - Petre I. Calistru
- Infectious Diseases Department, Universitatea de Medicina si Farmacie ”Carol Davila”, 050474 Bucuresti, Romania (P.I.C.)
- Infectious Diseases Department, Spitalul Clinic de Boli Infectioase si Tropicale ”Dr. Victor Babes”, 030303 Bucuresti, Romania
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Abbas Z, Abbas M. Is there a need for universal double reflex testing of HBsAg-positive individuals for hepatitis D infection? World J Hepatol 2024; 16:300-303. [PMID: 38577532 PMCID: PMC10989316 DOI: 10.4254/wjh.v16.i3.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/16/2024] [Accepted: 02/22/2024] [Indexed: 03/27/2024] Open
Abstract
Hepatitis D virus (HDV) can infect HBsAg-positive individuals, causing rapid fibrosis progression, early decompensation, increased hepatocellular carcinoma risk, and higher mortality than hepatitis B virus (HBV) mono-infection. Most countries lack high-quality HDV prevalence data, and the collection techniques employed often bias published data. In recent meta-analyses, HDV prevalence in HBsAg-positive patients reaches 5%-15% and is even significantly higher in endemic areas. Since HBV vaccination programs were implemented, HDV prevalence has decreased among younger populations. However, owing to immigrant influx, it has increased in some Western countries. The current practice of HDV screening in HBsAg-positive individuals is stepwise, based on physician's discretion, and limited to at-risk populations and may require numerous visits. Double reflex testing, which includes anti-HDV testing in all HBsAg-positive individuals and then HDV RNA testing for anti-HDV-positive ones, is uncommon. Reflex testing can identify more HDV infection cases and link identified patients to further care and follow-up. Moreover, laboratory-based double reflex screening is less biased than physician-led testing. Therefore, healthcare providers should learn about reflex testing, and federal and provincial hepatitis control programs should implement laboratory-based double reflex testing to obtain reliable HDV prevalence estimates. The test's cost-effectiveness depends on the number of HBV-positive patients screened to identify one HDV-positive patient. Such testing may be viable in areas with low HBsAg but high HDV prevalence. However, its economic impact on areas with low HDV prevalence needs further study.
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Affiliation(s)
- Zaigham Abbas
- Department of Hepatogastroenterology and Liver Transplantation, Dr. Ziauddin University Hospital, Karachi 75600, Sindh, Pakistan.
| | - Minaam Abbas
- Department of Medicine, University of Cambridge, Cambridge CB2 0SP, United Kingdom
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Sandmann L, Degasperi E, Port K, Aleman S, Wallin JJ, Manuilov D, Da BL, Cornberg M, Lampertico P, Maasoumy B, Wedemeyer H, Deterding K. Liver stiffness measurement as a noninvasive method for the diagnosis of liver cirrhosis in patients with chronic hepatitis D virus infection. Aliment Pharmacol Ther 2024; 59:752-761. [PMID: 38212890 DOI: 10.1111/apt.17878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/27/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Noninvasive tests (NITs) have been proposed as an alternative to liver biopsy for diagnosing liver cirrhosis. The evidence of NIT performance in patients with chronic hepatitis D (CHD) is limited. AIMS To evaluate the diagnostic performance of liver stiffness measurement (LSM) and other NITs in CHD patients. METHODS We evaluated the diagnostic performance of LSM by transient elastography for the detection of liver cirrhosis in a retrospective, multicentre cohort of 144 CHD patients with paired (±6 months) LSM and liver biopsies. RESULTS Cirrhosis was diagnosed histologically in 22 patients (15.3%). Mean LSM was significantly higher in patients with cirrhosis compared to those without fibrosis (23.4 vs 10.2 kPa, p < 0.0001) or with intermediate fibrosis (23.4 vs 13.5 kPa, p < 0.0001). In the detection of liver cirrhosis, LSM was superior to other NITs (AUROCs: 0.89 [LSM], 0.87 [D4FS], 0.74 [APRI], 0.73 [FIB-4], and 0.69 [AAR]). The optimal cut-off for identifying patients with liver cirrhosis was ≥15.2 kPa (Se 91%, Sp 84%, PPV 50%, NPV 98%). The ideal cut-off for diagnosing non-advanced liver fibrosis (Metavir ≤2) was <10.2 kPa (Se 55%, Sp 86%, PPV 90%, NPV 45%), correctly identifying 90% of patients. Data were validated in an independent cohort of 132 CHD patients. CONCLUSIONS LSM is a useful tool for identifying patients at risk for liver cirrhosis and is superior to other NITs. The cut-offs of <10.2 and < 15.2 kPa reliably diagnose non-advanced liver fibrosis and exclude cirrhosis in the majority of patients. However, LSM cannot completely replace liver biopsy in CHD patients.
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Affiliation(s)
- Lisa Sandmann
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
- D-SOLVE Consortium, an EU Horizon Europe Funded Project (no. 101057917)
| | - Elisabetta Degasperi
- D-SOLVE Consortium, an EU Horizon Europe Funded Project (no. 101057917)
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan, Milan, Italy
| | - Kerstin Port
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Soo Aleman
- D-SOLVE Consortium, an EU Horizon Europe Funded Project (no. 101057917)
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Infectious Diseases, Karolinska Institute, Stockholm, Sweden
| | | | | | - Ben L Da
- Gilead Sciences, Inc., Foster City, California, USA
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
- D-SOLVE Consortium, an EU Horizon Europe Funded Project (no. 101057917)
- German Center for Infection Research (DZIF), Hannover/Braunschweig, Germany
- Centre for Individualised Infection Medicine, Helmholtz Centre for Infection Research/Hannover Medical School, Hannover, Germany
| | - Pietro Lampertico
- D-SOLVE Consortium, an EU Horizon Europe Funded Project (no. 101057917)
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan, Milan, Italy
| | - Benjamin Maasoumy
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), Hannover/Braunschweig, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
- D-SOLVE Consortium, an EU Horizon Europe Funded Project (no. 101057917)
- German Center for Infection Research (DZIF), Hannover/Braunschweig, Germany
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Katja Deterding
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
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Toy M, Güler B, Somay K, Gençdal G, Yurdaydin C. Hepatitis delta virus infection in Turkey: A meta-analysis of prevalence. IJID REGIONS 2024; 10:228-234. [PMID: 38444561 PMCID: PMC10912444 DOI: 10.1016/j.ijregi.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/14/2024] [Accepted: 02/17/2024] [Indexed: 03/07/2024]
Abstract
Objectives Hepatitis delta virus (HDV) infection has been granted orphan disease status by the US Food and Drug Administration and the European Medicines Agency owing to its rarity and relatively limited research and treatment options. Turkey is considered an endemic country for the virus. We aimed to provide a current and updated country- and region-specific HDV infection prevalence. Methods In this meta-analysis, we searched databases, including MEDLINE, PUBMED, EMBASE, and UlakBim (Turkish Medical Index) published between January 1, 2006, and December 31, 2022. We included blood donor studies, outpatient clinic studies that comprised patients without cirrhosis, and inpatient clinical studies that comprised patients with cirrhosis. Turkey was divided into three regions: West, Central, and East Turkey. Results After a systematic assessment, 41 studies were included. Using a random-effects model, the estimated HDV prevalence among hepatitis B surface antigen-positive blood donors, outpatient clinic, and inpatient clinic patients were 3.37% (confidence interval [CI] 1.99-6.11), 5.05% (CI 4.00-6.23), and 29.06% (CI 10.45-51.79), respectively. The HDV prevalence among outpatient clinic patients in Western, Central, and Eastern regions were 3.38% (CI 2.47-4.44), 2.15% (CI 1.37-3.09), and 9.81% (CI 6.61-13.55), respectively. Conclusions East Turkey continues to have a high burden of HDV. Public health efforts, such as screening, should be targeted accordingly.
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Affiliation(s)
- Mehlika Toy
- Stanford University School of Medicine, Department of Surgery, Stanford, USA
| | - Begüm Güler
- Koç University Medical School, Department of Gastroenterology & Hepatology, Istanbul, Turkey
| | - Kayra Somay
- Koç University Medical School, Department of Gastroenterology & Hepatology, Istanbul, Turkey
| | - Genco Gençdal
- Koç University Medical School, Department of Gastroenterology & Hepatology, Istanbul, Turkey
| | - Cihan Yurdaydin
- Koç University Medical School, Department of Gastroenterology & Hepatology, Istanbul, Turkey
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Gigi E, Lagopoulos V, Liakos A. Management of autoimmune hepatitis induced by hepatitis delta virus. World J Gastroenterol 2024; 30:799-805. [PMID: 38516234 PMCID: PMC10950643 DOI: 10.3748/wjg.v30.i8.799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/02/2024] [Accepted: 01/30/2024] [Indexed: 02/26/2024] Open
Abstract
Approximately 12-72 million people worldwide are co-infected with hepatitis B virus (HBV) and hepatitis delta virus (HDV). This concurrent infection can lead to several severe outcomes with hepatic disease, such as cirrhosis, fulminant hepatitis, and hepatocellular carcinoma, being the most common. Over the past few decades, a correlation between viral hepatitis and autoimmune diseases has been reported. Furthermore, autoantibodies have been detected in the serum of patients co-infected with HBV/HDV, and autoimmune features have been reported. However, to date, very few cases of clinically significant autoimmune hepatitis (AIH) have been reported in patients with HDV infection, mainly in those who have received treatment with pegylated interferon. Interestingly, there are some patients with HBV infection and AIH in whom HDV infection is unearthed after receiving treatment with immunosuppressants. Consequently, several questions remain unanswered with the challenge to distinguish whether it is autoimmune or "autoimmune-like" hepatitis being the most crucial. Second, it remains uncertain whether autoimmunity is induced by HBV or delta virus. Finally, we investigated whether the cause of AIH lies in the previous treatment of HDV with pegylated interferon. These pressing issues should be elucidated to clarify whether new antiviral treatments for HDV, such as Bulevirtide or immu-nosuppressive drugs, are more appropriate for the management of patients with HDV and AIH.
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Affiliation(s)
- Eleni Gigi
- Hepatology Unit, The Second Internal Medicine Department, Aristotle University Medical School, Hippokrateio General Hospital, Thessaloniki 54642, Greece
| | - Vasileios Lagopoulos
- Department of Surgical, AHEPA General Hospital of Thessaloniki, Thessaloniki 54636, Greece
| | - Aris Liakos
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Hippokratio General Hospital, Aristotle University Thessaloniki, Thessaloniki 54642, Greece
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Demirel A, Uraz S, Deniz Z, Daglilar E, Basar O, Tahan V, Ozaras R. Epidemiology of hepatitis D virus infection in Europe: Is it vanishing? J Viral Hepat 2024; 31:120-128. [PMID: 37964693 DOI: 10.1111/jvh.13899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/13/2023] [Accepted: 11/04/2023] [Indexed: 11/16/2023]
Abstract
Co-infection with hepatitis delta virus (HDV) is a challenging health care problem worldwide, estimated to occur in approximately 5%-10% of patients with chronic hepatitis B virus (HBV) infection. While HBV prevalence is decreasing globally, the prevalence of HDV infection is rising in some parts mainly due to injection drug use, sexual transmission and immigration from high endemicity areas. Eastern Europe and the Mediterranean are among the regions with high rates of endemicity for HDV and the immigration from high endemicity areas to Central and Western Europe has changed the HDV epidemiology. We aimed to review the prevalence of HDV infection in Europe. A paucity of publication appears in many European countries. Prevalence studies from some countries are old dated and some other countries did not report any prevalence studies. The studies are accumulated in few countries. Anti-HDV prevalence is high in Greenland, Norway, Romania, Sweden and Italy. Belgium, France, Germany, Spain, Switzerland, Turkey and United Kingdom reported decreasing prevalences. Among cirrhotic HBV patients, Germany, Italy and Turkey reported higher rates of HDV. The studies including centres across the Europe reported that HIV-HBV coinfected individuals have higher prevalence of HDV infection. The immigrants contribute the HDV infection burden in Greece, Italy, and Spain in an increasing rate. Previous studies revealed extremely high rates of HDV infection in Germany, Greece, Italy and Sweden. The studies report a remarkably high prevalence of hepatitis delta among HIV/HBV-coinfected individuals, individuals who inject drugs, immigrants and severe HBV infected patients across Europe. The HDV infection burden still appears to be significant. In the lack of an effective HDV therapy, prevention strategies and active screening of HBV/HDV appear as the most critical interventions for reducing the burden of liver disease related to HDV infection in Europe.
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Affiliation(s)
- Aslıhan Demirel
- Department of Infectious Diseases, School of Medicine, Demiroglu Bilim University, Istanbul, Turkey
| | - Suleyman Uraz
- Department of Gastroenterology, School of Medicine, Demiroglu Bilim University, Istanbul, Turkey
| | - Zeynep Deniz
- School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Ebubekir Daglilar
- Department of Gastroenterology, West Virginia University-Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Omer Basar
- Division of Gastroenterology, Summa Health System, Akron, Ohio, USA
| | - Veysel Tahan
- Division of Gastroenterology, Summa Health System, Akron, Ohio, USA
- Division of Gastroenterology, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Resat Ozaras
- Department of Infectious Diseases, Medilife Hospital, Istanbul, Turkey
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d'Arminio Monforte A, Tavelli A, Salpini R, Piermatteo L, D'Anna S, Carrara S, Malagnino V, Mazzotta V, Brancaccio G, Marchetti GC, Rosselli Del Turco E, Rossotti R, Mussini C, Antinori A, Lo Caputo S, Ceccherini Silberstein F, Gaeta GB, Svicher V, Puoti M. Determinants of worse liver-related outcome according to HDV infection among HBsAg positive persons living with HIV: Data from the ICONA cohort. Liver Int 2024; 44:603-613. [PMID: 38100128 DOI: 10.1111/liv.15804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/30/2023] [Accepted: 11/12/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVES We aimed to study hepatitis D virus (HDV) prevalence and risk of progression to severe liver-related events (SLRE) in HBsAg positive people living with HIV (PLWH) in Italy; role of HDV-RNA copy levels, HCV coinfection and nadir CD4 counts were also investigated. METHODS People living with HIV (PLWH) from Italian Foundation cohort Naïve antiretrovirals (ICONA) with available HBsAg and HDV Ab were enrolled. HBsAg, HDV Ab, HDV-RNA and HDV genotypes were tested. PRIMARY END-POINT time from first HDV screening to Severe Liver Related Events (SLRE: decompensated cirrhosis, liver transplantation, HCC). Fine-grey regression models were used to evaluate the association of HDV Ab, HDV-RNA, HDV/HCV coinfection, CD4 nadir and outcome. Secondary end-points: time to SLRE or death; HDV Ab and HDV-RNA prevalence. RESULTS A total of 152/809 (18.8%) HBsAg positive PLWH showed HDV Ab reactivity; 63/93 (67.7%) were HDV-RNA positive. Being male, persons who inject drugs (PWID), HCV Ab positive, with FIB-4 > 3.25 were independent factors of HDV Ab positivity. In a median follow-up of 5 years, 37 PLWH (4.1% at 5-year) developed SLRE and 97 (12.0%) reached the SLRE or death end-point. HDV-RNA positive (independently from HDV-RNA copy level) PLWH had a 4.6-fold (95%CI 2.0-10.5) higher risk of SLRE than HDV negatives. PLWH positive for both HCV Ab and HDV Ab showed the highest independent risk of SLRE (ASHR: 11.9, 95%CI: 4.6-30.9 vs. HCV neg/HDV neg). Nadir CD4 < 200/mL was associated with SLRE (ASHR: 3.9, 95% 1.0-14.5). CONCLUSIONS One-fifth of the HBsAg positive PLWH harbour HDV infection, and are at high risk of progression to advanced liver disease. HCV contributes to worse outcomes. This population needs urgently effective treatments.
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Affiliation(s)
| | | | - Romina Salpini
- Department of Biology, University of Rome Tor Vergata, Rome, Italy
| | - Lorenzo Piermatteo
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Stefano D'Anna
- Department of Biology, University of Rome Tor Vergata, Rome, Italy
| | | | - Vincenzo Malagnino
- Department of Medicine of Systems, University of Rome Tor Vergata, Rome, Italy
| | | | - Giuseppina Brancaccio
- Infectious Diseases, Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Giulia Carla Marchetti
- Department of Health Sciences, ASST Santi Paolo e Carlo, Clinic of Infectious Diseases, University of Milan, Milan, Italy
| | - Elena Rosselli Del Turco
- Department of Medical and Surgical Sciences, Alma Mater Studiorum Bologna University, Bologna, Italy
| | - Roberto Rossotti
- Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Cristina Mussini
- Clinic of Infectious Diseases, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Antinori
- Clinical and Research Infectious Diseases Department, INMI, Rome, Italy
| | - Sergio Lo Caputo
- Clinic of Infectious Diseases, University of Foggia, Foggia, Italy
| | | | | | - Valentina Svicher
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Massimo Puoti
- Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, Niguarda Ca' Granda Hospital, Milan, Italy
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Abstract
Importance Hepatitis D virus (HDV) infection occurs in association with hepatitis B virus (HBV) infection and affects approximately 12 million to 72 million people worldwide. HDV causes more rapid progression to cirrhosis and higher rates of hepatocellular carcinoma than HBV alone or hepatitis C virus. Observations HDV requires HBV to enter hepatocytes and to assemble and secrete new virions. Acute HDV-HBV coinfection is followed by clearance of both viruses in approximately 95% of people, whereas HDV superinfection in an HBV-infected person results in chronic HDV-HBV infection in more than 90% of infected patients. Chronic hepatitis D causes more rapidly progressive liver disease than HBV alone. Approximately 30% to 70% of patients with chronic hepatitis D have cirrhosis at diagnosis and more than 50% die of liver disease within 10 years of diagnosis. However, recent studies suggested that progression is variable and that more than 50% of people may have an indolent course. Only approximately 20% to 50% of people infected by hepatitis D have been diagnosed due to lack of awareness and limited access to reliable diagnostic tests for the HDV antibody and HDV RNA. The HBV vaccine prevents HDV infection by preventing HBV infection, but no vaccines are available to protect those with established HBV infection against HDV. Interferon alfa inhibits HDV replication and reduces the incidence of liver-related events such as liver decompensation, hepatocellular carcinoma, liver transplant, or mortality from 8.5% per year to 3.3% per year. Adverse effects from interferon alfa such as fatigue, depression, and bone marrow suppression are common. HBV nucleos(t)ide analogues, such as entecavir or tenofovir, are ineffective against HDV. Phase 3 randomized clinical trials of bulevirtide, which blocks entry of HDV into hepatocytes, and lonafarnib, which interferes with HDV assembly, showed that compared with placebo or observation, these therapies attained virological and biochemical response in up to 56% of patients after 96 weeks of bulevirtide monotherapy and 19% after 48 weeks of lonafarnib, ritonavir, and pegylated interferon alfa treatment. Conclusions and Relevance HDV infection affects approximately 12 million to 72 million people worldwide and is associated with more rapid progression to cirrhosis and liver failure and higher rates of hepatocellular carcinoma than infection with HBV alone. Bulevirtide was recently approved for HDV in Europe, whereas pegylated interferon alfa is the only treatment available in most countries.
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Affiliation(s)
- Francesco Negro
- Division of Gastroenterology and Hepatology, Geneva University Hospitals, Geneva, Switzerland
| | - Anna S Lok
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor
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Moreno C, Qi X. Evolution in diagnosis and management of chronic liver diseases. United European Gastroenterol J 2023; 11:945-947. [PMID: 38015649 PMCID: PMC10720681 DOI: 10.1002/ueg2.12502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Affiliation(s)
- Christophe Moreno
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Xiaolong Qi
- Center of portal hypertension, Department of radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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Grecu LI, Sultana C, Pavel-Tanasa M, Ruta SM, Chivu-Economescu M, Matei L, Ursu RG, Iftimi E, Iancu LS. Non-Invasive Prediction Scores for Hepatitis B Virus- and Hepatitis D Virus-Infected Patients-A Cohort from the North-Eastern Part of Romania. Microorganisms 2023; 11:2895. [PMID: 38138039 PMCID: PMC10745361 DOI: 10.3390/microorganisms11122895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
Approximately 62-72 million people are infected worldwide with HDV. Patients with chronic hepatitis D (CHD) have a higher risk of developing cirrhosis or hepatocellular carcinoma (HCC) and an increased mortality rate compared to those with chronic hepatitis B (CHB). The stage of liver fibrosis or the risk of developing HCC can also be estimated by non-invasive scores, which are cost effective, easier to apply, and reproducible. In this study, we aimed to evaluate the predictive value of four non-invasive scores (FIB-4, APRI, AST/ALT ratio, and aMAP) in assessing severe fibrosis/cirrhosis and the presence of HCC in patients with HBV/HDV superinfection, as compared with HBV mono-infection. Our 8-year retrospective analysis revealed that HDV-infected patients had a 2-3 times higher risk of developing cirrhosis and HCC than HBV-mono-infected subjects. High AST and ALT baseline levels qualified as independent predictors for cirrhosis development in both groups. The following fibrosis scores, FIB-4, APRI score, and AAR, were significantly increased when cirrhosis was present at baseline and showed a good prediction for developing cirrhosis in the CHD group. The aMAP score, a risk predictor for HCC, showed significantly higher values in patients with HCC in both groups. Nonetheless, non-invasive scores should always be considered for monitoring patients with CHB and CHD, but only when associated with other diagnosis methods.
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Affiliation(s)
- Laura Iulia Grecu
- Department of Preventive Medicine and Interdisciplinarity, Microbiology Discipline, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.I.G.); (R.G.U.); (L.S.I.)
- Department of Emerging Viral Diseases, “Stefan S. Nicolau” Institute of Virology, 030304 Bucharest, Romania;
| | - Camelia Sultana
- Department of Emerging Viral Diseases, “Stefan S. Nicolau” Institute of Virology, 030304 Bucharest, Romania;
- Virology Discipline, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mariana Pavel-Tanasa
- Department of Immunology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Simona Maria Ruta
- Department of Emerging Viral Diseases, “Stefan S. Nicolau” Institute of Virology, 030304 Bucharest, Romania;
- Virology Discipline, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mihaela Chivu-Economescu
- Department of Cellular and Molecular Pathology, “Stefan S. Nicolau” Institute of Virology, 030304 Bucharest, Romania; (M.C.-E.)
| | - Lilia Matei
- Department of Cellular and Molecular Pathology, “Stefan S. Nicolau” Institute of Virology, 030304 Bucharest, Romania; (M.C.-E.)
| | - Ramona Gabriela Ursu
- Department of Preventive Medicine and Interdisciplinarity, Microbiology Discipline, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.I.G.); (R.G.U.); (L.S.I.)
| | - Elena Iftimi
- Department of Immunology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Luminita Smaranda Iancu
- Department of Preventive Medicine and Interdisciplinarity, Microbiology Discipline, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.I.G.); (R.G.U.); (L.S.I.)
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Rizzetto M. Hepatitis D Virus Infection. Reply. N Engl J Med 2023; 389:1441-1442. [PMID: 37819969 DOI: 10.1056/nejmc2309735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
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Wedemeyer H, Lampertico P. Bulevirtide for Chronic Hepatitis D. Reply. N Engl J Med 2023; 389:1248. [PMID: 37754294 DOI: 10.1056/nejmc2309033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
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Fasano M, Milella M, Carbonara S, Tundo P, Minniti S, Buccoliero G, Maci AM, Lo Caputo S, Santantonio TA. Apulian infectious diseases network: survey on the prevalence of delta infection among chronic HBV carriers in Apulia. Front Public Health 2023; 11:1247454. [PMID: 37822539 PMCID: PMC10562714 DOI: 10.3389/fpubh.2023.1247454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/07/2023] [Indexed: 10/13/2023] Open
Abstract
Background The current prevalence and clinical burden of Hepatitis Delta Virus (HDV) infection in Apulia are unknown. This study aimed to define the current epidemiological scenario of delta infection and to detect difficulties in the diagnosis and clinical management of HDV patients in Apulia. Methods From May to September 2022, a fact-finding survey was conducted at eight Infectious Diseases Units of the Apulian region; each Unit was asked to complete a questionnaire on screening and diagnosis of HDV infection and demographic, virological, and clinical characteristics of HDV patients. Results A total of 1,461 HBsAg-positive subjects were followed up on an outpatient basis. Screening for HDV ranged from 30 to 90% of HBsAg + carriers in a single center. Overall, 952 HBsAg ± subjects (65%) were tested for HDV, and 80/952 (8.4%) were anti-HDV positive. Serum HDV RNA was detected only in 15/80 (19%) anti-HDV-positive subjects, and 12/15 patients (80%) were viremic. Sixty-five anti-HDV-positive subjects (81%) were from Italy; risk factors for HDV acquisition included the presence of HDV infection in the family (29/80 = 36%), drug addiction (12/80 = 15%), and co-infection with HCV or HIV (7/80 = 9%). Liver cirrhosis and hepatocellular carcinoma were diagnosed in 41 (51%) and 4 (5%) patients, respectively. Fifty-seven patients (71%) received nucleos(t)ide analog treatment. Conclusions The results of this survey show that HDV screening is variable and insufficient, thus real prevalence data on delta infection are lacking in Apulia. Moreover, the HDV RNA test is not available in most laboratories and is not provided by the national health system. These results underline the need for an organizational model to optimize the management of HDV patients throughout the Apulian region.
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Affiliation(s)
- Massimo Fasano
- Infectious Diseases Unit, Ospedale della Murgia “F. Perinei”, Altamura, BA, Italy
| | - Michele Milella
- Infectious Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Sergio Carbonara
- Infectious Diseases Unit, Ospedale Vittorio Emanuele II, Bisceglie, BT, Italy
| | - Paolo Tundo
- Infectious Diseases Unit, Ospedale S. Caterina Novella, Galatina, LE, Italy
| | | | | | | | - Sergio Lo Caputo
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Teresa Antonia Santantonio
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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Kristian P, Hockicková I, Hatalová E, Žilinčanová D, Rác M, Bednárová V, Lenártová PD, Dražilová S, Skladaný Ľ, Schréter I, Jarčuška P, Halánová M. Is Slovakia Almost a Hepatitis D Free Country? Viruses 2023; 15:1695. [PMID: 37632037 PMCID: PMC10459979 DOI: 10.3390/v15081695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND It is assumed that the prevalence of hepatitis D in HBsAg-positive individuals reaches 4.5-13% in the world and on average about 3% in Europe. Data from several European countries, including Slovakia, are missing or are from an older period. METHODS We analyzed all available data on hepatitis D from Slovakia, including reports from the Slovak Public Health Authority and the results of one prospective study, and three smaller surveys. The determination of anti-HDV IgG and IgM antibodies and/or HDV RNA was used to detect hepatitis D. RESULTS In the years 2005-2022, no confirmed case of acute or chronic HDV infection was reported in Slovakia. The presented survey includes a total of 343 patients, of which 126 were asymptomatic HBsAg carriers, 33 acute hepatitis B, and 184 chronic hepatitis B cases. In a recent prospective study of 206 HBsAg-positive patients who were completely serologically and virologically examined for hepatitis B and D, only 1 anti-HDV IgG-positive and no anti-HDV IgM or HDV RNA-positive cases were detected. In other smaller surveys, two anti-HDV IgG-positive patients were found without the possibility of HDV RNA confirmation. In total, only 3 of 329 HBsAg-positive patients (0.91%) tested positive for anti-HDV IgG antibodies, and none of 220 tested positive for HDV RNA. CONCLUSION The available data show that Slovakia is one of the countries with a very low prevalence of HDV infection, reaching less than 1% in HBsAg-positive patients. Routine testing for hepatitis D is lacking in Slovakia, and therefore it is necessary to implement testing of all HBsAg-positive individuals according to international recommendations.
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Affiliation(s)
- Pavol Kristian
- Department of Infectology and Travel Medicine, Faculty of Medicine, Louis Pasteur University Hospital, Pavol Jozef Safarik University, 041 90 Kosice, Slovakia; (P.K.); (P.D.L.); (I.S.)
| | - Ivana Hockicková
- Department of Infectology and Travel Medicine, Faculty of Medicine, Louis Pasteur University Hospital, Pavol Jozef Safarik University, 041 90 Kosice, Slovakia; (P.K.); (P.D.L.); (I.S.)
| | - Elena Hatalová
- Department of Epidemiology, Faculty of Medicine, Pavol Jozes Safarik University, 040 11 Kosice, Slovakia; (E.H.); (V.B.); (M.H.)
| | - Daniela Žilinčanová
- II. Department of Internal Medicine, HEGITO Division Hepatology, Gastroenterology and Liver Transplantation, F. D. Roosevelt University Hospital, Slovak Medical University, 974 01 Banska Bystrica, Slovakia; (D.Ž.); (Ľ.S.)
| | - Marek Rác
- Department of Internal Medicine, Faculty Hospital, 949 01 Nitra, Slovakia;
| | - Veronika Bednárová
- Department of Epidemiology, Faculty of Medicine, Pavol Jozes Safarik University, 040 11 Kosice, Slovakia; (E.H.); (V.B.); (M.H.)
| | - Patrícia Denisa Lenártová
- Department of Infectology and Travel Medicine, Faculty of Medicine, Louis Pasteur University Hospital, Pavol Jozef Safarik University, 041 90 Kosice, Slovakia; (P.K.); (P.D.L.); (I.S.)
| | - Sylvia Dražilová
- 2nd Department of Internal Medicine, Faculty of Medicine, Louis Pasteur University Hospital, Pavol Jozef Safarik University, 041 90 Kosice, Slovakia; (S.D.); (P.J.)
| | - Ľubomír Skladaný
- II. Department of Internal Medicine, HEGITO Division Hepatology, Gastroenterology and Liver Transplantation, F. D. Roosevelt University Hospital, Slovak Medical University, 974 01 Banska Bystrica, Slovakia; (D.Ž.); (Ľ.S.)
| | - Ivan Schréter
- Department of Infectology and Travel Medicine, Faculty of Medicine, Louis Pasteur University Hospital, Pavol Jozef Safarik University, 041 90 Kosice, Slovakia; (P.K.); (P.D.L.); (I.S.)
| | - Peter Jarčuška
- 2nd Department of Internal Medicine, Faculty of Medicine, Louis Pasteur University Hospital, Pavol Jozef Safarik University, 041 90 Kosice, Slovakia; (S.D.); (P.J.)
| | - Monika Halánová
- Department of Epidemiology, Faculty of Medicine, Pavol Jozes Safarik University, 040 11 Kosice, Slovakia; (E.H.); (V.B.); (M.H.)
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Xu HY, Yang JO, Chen PH, Han SHB. Bulevirtide and emerging drugs for the treatment of hepatitis D. Expert Opin Biol Ther 2023; 23:1245-1253. [PMID: 37853604 DOI: 10.1080/14712598.2023.2273260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/17/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Hepatitis delta virus (HDV) causes acute and chronic liver disease that requires the co-infection of the Hepatitis B virus and can lead to significant morbidity and mortality. Bulevirtide is a recently introduced entry inhibitor drug that acts on the sodium taurocholate cotransporting peptide, thereby preventing viral entry to target cells in chronic HDV infection. The mainstay of chronic HDV therapy prior to bulevirtide was interferon alpha, which has an undesirable side effect profile. AREAS COVERED We review bulevirtide data from recent clinical trials in Europe and the United States. Challenges to development and implementation of bulevirtide are discussed. Additionally, we review ongoing trials of emerging drugs for HDV, such as pegylated interferon lambda and lonafarnib. EXPERT OPINION Bulevirtide represents a major shift in treatment for chronic HDV, for which there is significant unmet need. Trials that compared bulevirtide in combination with interferon alpha vs interferon alpha monotherapy demonstrated significant increase in virologic response. Overall, treatment with different doses of bulevirtide were comparable. Bulevirtide was generally well tolerated, and no serious adverse events occurred. Understanding the true prevalence of HDV, as well as continued studies of emerging drugs will prove valuable to the larger goal of eradication of Hepatitis D.
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Affiliation(s)
- Helen Y Xu
- Department of Medicine, UCLA Health, Los Angeles, CA, USA
| | - Jamie O Yang
- Department of Medicine, UCLA Health, Los Angeles, CA, USA
| | - Phillip H Chen
- Clinical Fellow in Gastroenterology, Department of Gastroenterology, UCLA Health, Los Angeles, CA, USA
| | - Steven-Huy B Han
- Pfleger Liver Institute, UCLA Health, 200 Medical Plaza, Los Angeles, CA, USA
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