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Nathani R, Leibowitz R, Giri D, Villarroel C, Salman S, Sehmbhi M, Yoon BH, Dinani A, Weisberg I. The Delta Delta: Gaps in screening and patient assessment for hepatitis D virus infection. J Viral Hepat 2023; 30:195-200. [PMID: 36458863 DOI: 10.1111/jvh.13779] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/18/2022] [Accepted: 11/26/2022] [Indexed: 12/09/2022]
Abstract
Hepatitis D virus (HDV) infection is highly prevalent in patients with chronic hepatitis B (CHB). AASLD guidelines recommend a risk-based screening approach. Our aim was to ascertain if the risk-based approach leads to appropriate HDV screening, identify targets to improve screening rates, and study HDV clinical burden. CHB patients screened for HDV from 01/2016 to 12/2021 were identified. Level of training and specialty of providers ordering HDV screening tests were determined. HDV seropositive (HDV+) patient charts were reviewed for the presence of individual risk factors per the AASLD guidelines to determine if they met screening criteria. The severity of liver disease at the time of HDV screening was compared between the HDV+ group and a matched (based on age, hepatitis B e antigen status, BMI and sex) HDV seronegative (HDV-) group. During the study period, 1444/11,190 CHB patients were screened for HDV. Most screening tests were ordered by gastroenterology (90.2%) specialists and attending physicians (80.5%). HDV+ rate was 88/1444 (6%), and 72 HDV+ patients had complete information for analysis. 18% of HDV+ patients would be missed by a risk-based screening approach due to unreported or negative risk factors (see Table). A significantly higher number of HDV+ patients had developed significant fibrosis (p = 0.001) and cirrhosis (p < 0.01) by the time of screening than HDV- (n = 67) patients. In conclusion, targeted interventions are needed towards trainees and primary care clinics to improve screening rates. Current risk-based criteria do not appropriately screen for HDV. It is time for universal screening of HDV in CHB patients.
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Affiliation(s)
- Rohit Nathani
- Department of Medicine, Icahn School of Medicine at Mount Sinai Morningside, and West Hospital, New York, New York, USA
| | - Randy Leibowitz
- Department of Medicine, Icahn School of Medicine at Mount Sinai Morningside, and West Hospital, New York, New York, USA
| | - Dewan Giri
- Department of Medicine, Icahn School of Medicine at Mount Sinai Beth Israel Hospital, New York, New York, USA
| | - Carolina Villarroel
- Department of Medicine, Icahn School of Medicine at Mount Sinai Beth Israel Hospital, New York, New York, USA
| | - Sidra Salman
- Department of Medicine, Icahn School of Medicine at Mount Sinai Morningside, and West Hospital, New York, New York, USA
| | - Mantej Sehmbhi
- Department of Medicine, Icahn School of Medicine at Mount Sinai Morningside, and West Hospital, New York, New York, USA
| | - Bo Hyung Yoon
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai Beth Israel, Morningside, and West Hospital, New York, New York, USA
| | - Amreen Dinani
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ilan Weisberg
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai Beth Israel, New York, New York, USA
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Wranke A, Hardtke S, Heidrich B, Dalekos G, Yalçin K, Tabak F, Gürel S, Çakaloğlu Y, Akarca US, Lammert F, Häussinger D, Müller T, Wöbse M, Manns MP, Idilman R, Cornberg M, Wedemeyer H, Yurdaydin C. Ten-year follow-up of a randomized controlled clinical trial in chronic hepatitis delta. J Viral Hepat 2020; 27:1359-1368. [PMID: 32707605 DOI: 10.1111/jvh.13366] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 12/13/2022]
Abstract
Hepatitis delta virus (HDV) infection causes the most severe form of viral hepatitis. PEG-interferon alpha-2a (PEG-IFNα-2a) is the only effective treatment but its long-term clinical impact is unclear. The aim of this study was to investigate the long-term outcome after 48 weeks of pegylated interferon alpha-2a therapy. We performed a retrospective follow-up study of the Hep-Net-International-Delta-Hepatitis-Intervention-Study 1 (HIDIT-I trial). Patients had received 48 weeks of treatment with either PEG-IFNα-2a plus adefovir dipivoxil (ADV) (Group I), PEG-IFNα-2a alone (Group II) or adefovir dipivoxil alone (Group III). Liver-related complications were defined as liver-related death, liver transplantation, liver cancer and hepatic decompensation defined as development of Child-Pugh scores B or C or an increase in Model for End-stage Liver Disease (MELD) scores of five or more points in relation to baseline values. Patients were considered for further analysis when they were retreated with PEG-IFNα-2a. Follow-up data (at least 1 visit beyond post-treatment week 24) were available for 60 patients [Group I, (n = 19), Group II (n = 20), Group III (n = 21)]. Mean time of follow-up was 8.9 (1.6 - 13.4) years. 19 patients were retreated with IFN-based therapy: 42% (n = 8) in PEG-IFNα-2a arms and 58% (n = 11) in the adefovir only arm. Clinical complications on long-term follow-up occurred in 17 patients and were associated with nonresponse to therapy and baseline cirrhosis. The annual event-free survival rate in patients with cirrhosis vs noncirrhotic patients at year 5 and 10 was 70% vs 91% and 35% vs 76%. Long-term follow-up of a large randomized clinical trial suggests that off-treatment HDV RNA response to PEG-IFNα-2a treatment leads to improved clinical long-term outcome.
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Affiliation(s)
- Anika Wranke
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Svenja Hardtke
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research (DZIF), Partner Site HepNet Study-House, Hannover, Germany
| | - Benjamin Heidrich
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research (DZIF), Partner Site HepNet Study-House, Hannover, Germany
| | - George Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, University Hospital of Larissa, Larissa, Greece
| | - Kendal Yalçin
- Dicle University Medical Faculty, Diyarbakir, Turkey
| | - Fehmi Tabak
- Department of Infectious Diseases Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Selim Gürel
- Uludağ University Medical School, Bursa, Turkey
| | | | | | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Dieter Häussinger
- Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Düsseldorf, Germany
| | | | - Michael Wöbse
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research (DZIF), Partner Site HepNet Study-House, Hannover, Germany
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research (DZIF), Partner Site HepNet Study-House, Hannover, Germany
| | - Heiner Wedemeyer
- German Center for Infection Research (DZIF), Partner Site HepNet Study-House, Hannover, Germany.,Department of Gastroenterology and Hepatology, Essen University Hospital, Medical Faculty of the University Duisburg-Essen, Essen, Germany
| | - Cihan Yurdaydin
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey.,Department of Gastroenterology and Hepatology, Koç University Medical School, Istanbul, Turkey
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