1st Central and Eastern European Meeting on Viral Hepatitis and Co-infection with HIV 22 - 23 June 2015, Warsaw, Poland

DOES HEPATITIS D IN HBV/HIV CO-INFECTED PATIENTS AFFECT LIVER FUNCTION?

*Joanna Kozowska, **Joanna Kubicka,

*Joanna Jaboska, *Tomasz Mikua, **Ewa Siwak, ***Tomasz Dyda, *Alicja Wierciska-Drapao

*Hepatology and AIDS Department, Medical University of Warsaw; Warsaws Hospital for Infectious Diseases **Outpatient Clinic, Warsaws Hospital for Infectious Diseases ***Molecular Diagnostics Laboratory, Warsaws Hospital for Infectious Diseases

BACKGROUND

- HDV prevalence among HIV/HBV patients in Europe 14.5% 1 - HDV associated with a higher rate of death and liver decompensation events in HIV-infected patients 1,2

- HDV infection has no impact on HIV progression 1,3 and vice versa 4

- Viral interference between hepatitis B, C and D in HIV-positive patients

HDV inhibits HBV replication 1,5 HDV inhibits HCV replication 5 reciprocal inhibition between HBV and HCV 6

1. Soriano et al. 2011, AIDS. 2. Fernandez-Montero et al. 2014, Clin Infect Dis. 3. Lee et al. 2015, J MicrobiolImmunol Infect. 4. Nicolini et al. 2015, Antivir Ther. 5. Boyd et al. 2010 J Viral Hepat. 6. Morsica et al. 2009, J Acquir Immune Defic Syndr

BACKGROUND

ART regimens (including drugs active against HBV)

could have beneficial effect on the clinical course of hepatitis D in HIV-positive patients

Onali et al. 2014, Antivir Ther. Soriano et al. 2014, AIDS.

AIM OF THE STUDY

The aim of the study was to determine the influence of HDV infection on the severity of liver disease

in HIV/HBV co-infected patients

METHODS

The study group included 65 HIV/HBV co-infected patients Serum HDV IgG antibodies were tested with EIA test (Dia.Pro)

HDV RNA was measured using HDV Real-TM Sacace Biotech

test Biochemical, serological, virological and immunological

examination was also carried out along with abdominal ultrasound

STUDY GROUP

Age, mean years (range) 41 (20-56)

Gender, M/F 60 / 5

Transmission route, IDU / MSM / Hx 15 / 33 / 10

HCV infection (%) 30 (46%)

HBeAg, pos (%) 21 (32%)

CD4, mean cells/ul (SD) 455 (182)

ARV treated at analysis (%) 58 (89%)

RESULTS

HDV IgG were detected in 15/65 (23%) patients with HIV/HBV co-infection

HDV RNA was detected in 9/15 of HDV ab-positive patients and in one HDV ab-negative patient, who was IDU (15% of patients with HIV/HBV co-infection)

13/16 HIV/HBV/HDV co-infected patients had prior history of intravenous drug use

RESULTS

All ARV treated patients had low or undetectable levels of HBV DNA

No significant relationship was established between HDV infection and HBeAg positivity, CD4 cell count or immunological or virological response on ARV treatment.

RESULTS

Among 16 patients with HIV/HBV/HDV co-infection 15 (94%) were also infected with HCV

Among 49 remaining (non-infected with HDV) 15 (31%) were HCV positive

RESULTS

Taking into account a minimum of 5 results

of the given parameter for HDV-positive and

HDV-negative patients, statistically significant

differences were observed for the following

parameters (in red):

RESULTS LIVER PARAMETERS

Median Q25 Q75 neg vs pos

ALAT all 40 28,5 59 HDV neg 37 28 55 HDV pos 56 43 82 p

RESULTS

Median Q25 Q75 neg vs pos

Cholesterol all 4,52 3,92 5,17

HDV neg 4,43 3,95 5,1

HDV pos 4,41 3,7 4,98 ns

Hemoglobin all 14,6 13,5 15,5

HDV neg 15 13,9 15,8

HDV pos 14,5 13,2 15,6 p

RESULTS

Cirrhosis was found in 4 HDV-antibodies-positive patients, but HDV-RNA was not detected in 2 of them

Cirrhosis was not found in any of HDV-antibodies-negative patients, along with 8/10 HDV-RNA-positive patients also cirrhosis-free.

These are preliminary data, observation is continued

CONCLUSIONS

HDV infection is common in Polish HIV/HBV co-infected patients with a history of IDU

Advanced liver dysfunction in HIV/HBV/HDV co-infected patients is not as frequent as expected - it needs further observation

Assessment of the impact of HDV infection on liver disease progression in HIV/HBV co-infection is complicated by concomitant HCV infection

Does hepatitis D in HBV/HIV co-infected patients affect liver function?backgroundbackgroundAim of the studyMethodsStudy groupResultsResultsResultsResultsResults liver parametersResultsresultsConclusions