HDV Contributes to Serious Complications of HBV-Associated Liver Disease

Hospitalizations among patients infected with both hepatitis B virus (HBV) and hepatitis D virus (HDV) during the period 2010 through 2018 were far less common than those of patients with HBV only, and patients with HDV were more often male, of Hispanic ethnicity, and living in the Northeastern US, according to research published in the Journal of Viral Hepatitis.

“In the United States, hepatitis D is not a reportable condition, leading to gaps in epidemiological and clinical knowledge,” the investigators noted. In anticipation of the approval of bulevirtide by the US Food and Drug Administration (which occurred in June 2022), the researchers set out to produce accurate, current epidemiological data to facilitate targeting high-risk populations for diagnosis and treatment of HDV.

Using hospitalization data from the 2010–2018 National Inpatient Sample from the Healthcare Cost and Utilization Project, the investigators identified 3825 hepatitis D-associated hospitalizations, in comparison to 413,355 hospitalizations of patients diagnosed with hepatitis B without hepatitis D (HBV only).

In the United States, the prevalence of HDV infections among hepatitis B surface antigen (HBsAg)-positive individuals is estimated to be between 5.9% and 7.2%. HDV, however, has an outsized impact on serious complications of liver disease, as it contributes to 18% of cases of cirrhosis and 20% of cases of hepatocellular carcinoma among patients with HBV, the authors noted. Patients with both HDV and HBV also have significantly higher rates of liver failure, portal hypertension, ascites, and thrombocytopenia than the HBV-only cohort.

“The hospitalization rate of hepatitis D was between 6.9 and 20.7 per 10,000,000 but did not change significantly over time,” the authors wrote. However, they observed, hospitalization rates for patients with HBV only increased during the period 2015–2018. “This is consistent with a disturbing trend in the United States,” the investigators wrote. “Since the advent of widespread hepatitis B vaccination, cases of acute hepatitis B in the United States, as reported by the Centers for Disease Control and Prevention (CDC), have decreased each year; however, after 2010, this has stagnated and has even begun to increase slightly in recent years.”

Although rates of mortality among hospitalized patients with hepatitis were not higher than those among patients with HBV only, “we found that within the hepatitis D cohort, older age and the presence of alcoholic cirrhosis were both major risk factors of mortality.”

The investigators concluded, “Hepatitis D appeared to be largely underdiagnosed in the United States. There is a need for routine hepatitis D testing after a confirmed chronic hepatitis B diagnosis, especially considering the severity of the disease,” as well as the availability of hepatitis D-specific therapy.

—Rebecca Mashaw

Wasuwanich P, Striley CW, Kamili S, Teshale EH, Seaberg EC, Karnsakul W. Hepatitis D-associated hospitalizations in the United States: 2010–2018. J Viral Hepat. 2022;29(3):218-226.  https://doi.org/10.1111/jvh.13645