Characterizing Hepatitis Delta in Spain and the gaps in its management.

Fecha de publicación: 20/06/2024

Autores de IIS La Fe

• Mercedes Rodríguez Serna

  Autor

• María García Eliz

  Autor

• Sara Lorente Perez

  Autor

Participantes ajenos a IIS La Fe

• Rodriguez-Tajes, Sergio
• Palom, Adriana
• Giraldez-Gallego, Alvaro
• Moreno, Antonio
• Urquijo, Juan Jose
• Alvarez-Arguelles, Marta
• Diago, Moises
• Fuentes, Javier
• Martinez-Sapina, Ana Maria
• Castillo, Pilar
• Casado, Marta
• Perez-Campos, Elena
• Munoz, Raquel
• Hernandez-Conde, Marta
• Morillas, Rosa Maria
• Granados, Rafael
• Miquel, Mireia
• Morillas, Maria Julia
• Garcia-Retortillo, Monserrat
• Carrion, Jose Antonio
• Moreno, Jose Maria
• Monton, Cristina
• Gonzalez-Santiago, Jesus Manuel
• Cabezas, Joaquin
• Mateos, Beatriz
• Vazquez-Rodriguez, Sergio
• Diaz-Fontenla, Fernando
• Pinazo, Jose Maria
• Delgado, Merce
• Perez-Palacios, Domingo
• Horta, Diana
• Fernandez-Marcos, Cristina
• Lopez, Carmen
• Calleja, Jose Luis
• Fernandez, Inmaculada
• Garcia-Samaniego, Javier
• Forns, Xavier
• Buti, Maria
• Lens, Sabela

Grupos

• Dermatología y Regeneración Tisular

  

  Leader

  Rafael Botella Estrada

• Hepatología, Cirugia Hepatobiliopancreática y Trasplantes

  

  Leader

  Marina Berenguer Haym

Abstract

BACKGROUND AND AIMS: Chronic hepatitis D (CHD) is a severe form of chronic viral hepatitis. The estimated hepatitis delta prevalence in Spain is around 5% of patients with hepatitis B. Reimbursement of new antiviral therapies (Bulevirtide, BLV) was delayed in our country until February 2024. We aimed to characterize the clinical profile of patients with HDV/HBV infection in Spain and current barriers in their management at the time of BLV approval. METHOD: Multicenter registry including patients with positive anti-HDV serology actively monitored in 30 Spanish centers. Epidemiological, clinical and virological variables were recorded at the start of follow-up and at the last visit. RESULTS: We identified 329 anti-HDV patients, 41% were female with median age 51 years. The most common geographical origin was Spain (53%) and East Europe (24%). Patients from Spain were older and had HCV and HIV coinfection probably associated to past drug injection (p<0.01). HDV-RNA was positive in 138 of 221 assessed (62%). Liver cirrhosis was present at diagnosis in 33% and it was more frequent among viremic patients (58% vs 25%, p<0.01). After a median follow-up of 6 (3-12) years, 44 (16%) resolved infection (18 spontaneously and 26 after Peg-INF). An additional 10% of patients developed cirrhosis (n=137) during follow-up (45% had portal hypertension and 14% liver decompensation). Liver disease progression was associated to persisting viremia. CONCLUSION: One-third of the patients with CHD already have cirrhosis at diagnosis. Persistence of positive viremia is associated to rapid liver disease progression. Importantly, barriers to locally determine/quantify HDV-RNA were present.