A 28-Year Study of the Course of Hepatitis Δ Infection: A Risk Factor for Cirrhosis and Hepatocellular Carcinoma

Raffaella Romeo, Ersilio Del Ninno, Mariagrazia Rumi, Antonio Russo, Angelo Sangiovanni, Roberto de Franchis, Guido Ronchi, Massimo Colombo

Research output: Contribution to journalArticle

Abstract

Background & Aims: Chronic infection with hepatitis Δ virus (HDV) is a risk factor for cirrhosis and hepatocellular carcinoma (HCC); predictors of disease outcome are, however, poorly defined. We tracked the course of HDV infection in 299 patients over a mean period of 233 months. Methods: We analyzed data from patients who had been HDV positive for at least 6 months (230 males; mean age, 30 years) admitted from 1978 to 2006 to Maggiore Hospital, Milan. HDV infection was defined by the presence of HDV antigen in liver tissue or serum HDV RNA in anti-HDV/hepititis B surface antigen seropositive patients. At enrollment, 7 patients had acute hepatitis, 101 had mild-moderate chronic hepatitis, 76 had severe chronic hepatitis, and 104 had histologic or clinical cirrhosis. Ninety patients were treated with interferon, 62 with corticosteroids, and 12 with nucleoside analogues; 135 received no therapy. Results: Over a mean period of 233 months, 82 patients developed cirrhosis. Among the 186 total patients with cirrhosis, 46 developed HCC, 43 ascites, 44 jaundice, and 1 encephalopathy. Female sex, alcohol abuse, and HDV replication were associated with liver decompensation; HBV replication and interferon were associated with HCC development. By the end of the study, 186 patients were still alive, 63 had died, and 29 had received liver transplants. The main cause of death was liver failure (n = 37, 59%); HDV replication was the only independent predictor of mortality. Conclusions: Persistent HDV replication leads to cirrhosis and HCC at annual rates of 4% and 2.8%, respectively, and is the only predictor of liver-related mortality.

Original languageEnglish
Pages (from-to)1629-1638
Number of pages10
JournalGastroenterology
Volume136
Issue number5
DOIs
Publication statusPublished - May 2009

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Hepatitis
Hepatocellular Carcinoma
Fibrosis
Infection
Liver
Chronic Hepatitis
Interferons
Hepatitis Viruses
Mortality
Liver Failure
Brain Diseases
Surface Antigens
Jaundice
Nucleosides
Ascites
Alcoholism
Cause of Death
Adrenal Cortex Hormones
RNA
Transplants

ASJC Scopus subject areas

  • Gastroenterology

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A 28-Year Study of the Course of Hepatitis Δ Infection : A Risk Factor for Cirrhosis and Hepatocellular Carcinoma. / Romeo, Raffaella; Del Ninno, Ersilio; Rumi, Mariagrazia; Russo, Antonio; Sangiovanni, Angelo; de Franchis, Roberto; Ronchi, Guido; Colombo, Massimo.

In: Gastroenterology, Vol. 136, No. 5, 05.2009, p. 1629-1638.

Research output: Contribution to journalArticle

Romeo, Raffaella ; Del Ninno, Ersilio ; Rumi, Mariagrazia ; Russo, Antonio ; Sangiovanni, Angelo ; de Franchis, Roberto ; Ronchi, Guido ; Colombo, Massimo. / A 28-Year Study of the Course of Hepatitis Δ Infection : A Risk Factor for Cirrhosis and Hepatocellular Carcinoma. In: Gastroenterology. 2009 ; Vol. 136, No. 5. pp. 1629-1638.
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AU - Russo, Antonio

AU - Sangiovanni, Angelo

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