One-quarter of chronic hepatitis D patients reach HDV-RNA decline or undetectability during the natural course of the disease.

Abstract

BACKGROUND:

Spontaneous HDV-RNA fluctuations, assessed by nonstandardised in-house assays, have been reported during the course of chronic hepatitis delta (CHD).

AIMS:

To evaluate changes in serum HDV-RNA concentrations in untreated CHD patients and correlate these changes with other HBV markers.

METHODS:

A total of 323 consecutive serum samples from 56 CHD patients (detectable HDV-RNA) followed for >3 years were retested for HDV-RNA levels by a sensitive technique using the first WHO international HDV-RNA standard. Quantitative HBsAg, HBV-DNA, and HBV-RNA were also determined.

RESULTS:

Most participants were male, middle-aged, white European, and HBeAg-negative (82%). Almost half had liver cirrhosis and 64% were receiving nucleos(t)ide analogues. At inclusion, median-HDV-RNA was 5.3 (4.2-6.5) log10 IU/mL, HBsAg 4.0 (3.5-4.3) log10 IU/mL, and HBV-DNA 1.6 (1.0-2.6) log10 IU/mL; ALT values were normal in 13 (23%). During a mean follow-up of 5.6 (3-16) years, 14 (25%) showed ≥2log10 HDV-RNA decline, including 11 (20%) who spontaneously achieved undetectable HDV-RNA. Four patients (7%) lost HBsAg, with undetectable HDV-RNA. The remaining 42 (75%) had persistently detectable HDV-RNA. During follow-up, patients with a ≥2log10 HDV-RNA decline showed a greater HBsAg drop (-0.7 ± 1.1 vs -0.09 ± 0.9 log IU/mL; P = 0.039) than those with a <2 log10 HDV-RNA decline. Overall, ALT and HBV-DNA levels decreased over time. There were no differences in clinical outcomes between groups.

CONCLUSIONS:

One-quarter of untreated CHD patients showed a ≥2log10 decline in HDV-RNA and 20% reached HDV-RNA undetectability during a mean follow-up of 5.6 years. The decline was associated with ALT decrease. These findings have implications for designing new therapies for CHD.

• Authors: Adriana Palom, Sara Sopena, Mar Riveiro-Barciela, Angela Carvalho-Gomes, Antonio Madejón, Sergio Rodriguez-Tajes, Luisa Roade, María García-Eliz, Javier García-Samaniego, Sabela Lens, Marina Berenguer-Hayme, Francisco Rodríguez-Frías, Helena Hernandez-Évole, Ana Isabel Gil-García, Ana Barreira, Rafael Esteban, Maria Buti
• Journal: Alimentary pharmacology & therapeutics (Aliment Pharmacol Ther) Vol. 54 Issue 4 Pg. 462-469 (08 2021) ISSN: 1365-2036 [Electronic] England
• PMID: 34181772 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2021 John Wiley & Sons Ltd.

Chemical References

• DNA, Viral
• Hepatitis B Surface Antigens
• RNA

Topics

• DNA, Viral
• Hepatitis B Surface Antigens
• Hepatitis B virus (genetics)
• Hepatitis D (diagnosis, epidemiology)
• Hepatitis D, Chronic (drug therapy)
• Hepatitis Delta Virus (genetics)
• Humans
• Male
• Middle Aged
• RNA