Influence of hepatitis delta virus infection on morbidity and mortality incompensated cirrhosis type B

Background-The effect of hepatitis delta virus (HDV) infection on the clini cal course of cirrhosis type B is poorly defined. Aims-To investigate the impact of HDV status on morbidity and mortality in cirrhosis type B. Patients/Methods-Retrospective cohort study of 200 Western European patient s with compensated cirrhosis type B followed for a median period of 6.6 yea rs. Results-At diagnosis, 20% of patients had antibodies to HDV (anti-HDV); med ian age was lower in anti-HDV positive cirrhotics (34 v 48 years respective ly). Kaplan-Meier five year probability of hepatocellular carcinoma (HCC) w as 6, 10, and 9% in anti-HDV positive/HBeAg negative, anti-HDV negative/HBe Ag negative, and anti-HDV negative/HBeAg positive cirrhotics respectively; the corresponding figures for decompensation were 22, 16, and 19% and for s urvival they were 92, 89, and 83% respectively. Cox regression analysis ide ntified age, albumin concentration, gamma-globulin concentration, and HDV s tatus as significant independent prognostic variables. After adjustment for clinical and serological differences at baseline, the risk (95% confidence interval) for HCC, decompensation, and mortality was increased by a factor of 3.2 (1.0 to 10), 2.2 (0.8 to 5.7), and 2.0 (0.7 to 5.7) respectively in anti-HDV positive relative to HDV negative cirrhotic patients. The adjuste d estimated five year risk for HCC was 13, 4, and 2% for anti-HDV positive/ HBeAg negative, anti-HDV negative/HBeAg negative, and anti-HDV negative/HBe Ag positive cirrhotics respectively; the corresponding figures for decompen sation were 18, 8, and 14% and for survival 90, 95, and 93% respectively. Conclusions-HDV infection increases the risk for HCC threefold and for mort ality twofold in patients with cirrhosis type B.