Published online Jun 27, 2020. doi: 10.4254/wjh.v12.i6.277
Peer-review started: February 9, 2020
First decision: March 18, 2020
Revised: April 7, 2020
Accepted: May 5, 2020
Article in press: May 5, 2020
Published online: June 27, 2020
Processing time: 139 Days and 11.9 Hours
Delta hepatitis is a rare infection with an aggressive disease course. For almost three decades, however, there have been no epidemiological studies in our traditionally endemic area.
To investigate the prevalence of delta hepatitis in a sample of patients with chronic hepatitis B virus (HBV) infection followed at a Hepatology Unit in Valencia, Spain.
Retrospective evaluation of anti-hepatitis D virus-immunoglobulin G seroprevalence among patients with chronic HBV infection (n = 605) followed at a reference Hepatology Unit in Spain.
The prevalence of anti-hepatitis D virus-immunoglobulin G among HBV-infected patients was 11.5%: Male (63%) and median age of 52 years. The majority were born in Spain (67%) and primarily infected through intravenous drug use. However, a significant percent (24.5%), particularly those diagnosed in more recent years, were migrants presumably nosocomially infected. Comorbidities such as diabetes (8.5%), obesity/overweight (55%), and alcohol consumption (34%) were frequent. A high proportion of patients developed liver complications such as cirrhosis (77%), liver decompensation (81%), hepatocellular carcinoma (HCC) (16.5%), or required liver transplantation (LT) (59.5%). Diabetes was associated with progression to cirrhosis, LT, and death. Male sex, increasing age, and alcohol were associated with LT and HCC. Compared to HBV mono-infected patients, delta individuals developed cirrhosis and liver decompensation more frequently, with no differences in HCC rates.
Patients infected in the 1980’s were mostly locals infected through intravenous drug use, whereas those diagnosed recently are frequently non-Spanish natives from endemic areas. Regardless of their origin, patients are predominantly male with significant comorbidities, which potentially play a major role in disease progression. We confirm a high rate of subsequent liver complications.
Core tip: Our study shows that there has been a change in the delta hepatitis virus-infected patient profile in our unit. Most patients infected in the 1980s, due to intravenous drug abuse, have progressed to cirrhosis and/or hepatocellular carcinoma and therefore still represent a significant burden on our Hepatology Unit. However, our main concern is with newly diagnosed patients, as there is a clear delay in the diagnosis of infection and cirrhosis. In addition, follow-up in their home countries has been poor. Most of them come from Eastern Europe and prior medical intervention was the main route of infection. We must also take into account the presence of comorbidities, e.g., metabolic syndrome and alcohol intake, which may contribute to the aggressive progression of the disease. Therefore, we must devote our efforts to controlling these aspects and finding an effective treatment, given the poor results offered by pegylated-α-interferon.