Liver and Bile
Hepatology. 2024;79(5):1129–40
Association of hepatitis delta virus with liver morbidity and mortality: A systematic literature review and meta-analysis
Background and aims: Studies have suggested that patients with chronic hepatitis B, either co- or superinfected, have more aggressive liver disease progression than those with the hepatitis delta virus (HDV). This systematic literature review and meta-analysis examined whether HDV RNA status is associated with increased risk of advanced liver disease events in patients who are hepatitis B surface antigen- and HDV antibody-positive.
Approach and results: A total of 12 publications were included. Relative rates of progression to advanced liver disease event for HDV RNA+/detectable versus HDV RNA-/undetectable were extracted for analysis. Reported odds ratio (OR) and hazard ratios (HRs) with 95% confidence interval (CI) were pooled using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. The presence of HDV RNA+ was associated with an increased risk of any advanced liver disease event (random effect [95% CI]: risk ratio = 1.48 [0.93–2.33]; HR = 2.62 [1.55–4.44]). When compared to the patients with HDV RNA- status, HDV RNA+ was associated with a significantly higher risk of progressing to compensated cirrhosis (risk ratio = 1.74 [1.24–2.45]) decompensated cirrhosis (HR = 3.82 [1.60–9.10]), hepatocellular carcinoma (HR = 2.97 [1.87–4.70]), liver transplantation (HR = 7.07 [1.61–30.99]), and liver-related mortality (HR = 3.78 [2.18–6.56]).
Conclusions: The patients with HDV RNA+ status have a significantly greater risk of liver disease progression than the patients who are HDV RNA-. These findings highlight the need for improved hepatitis delta virus (HDV) screening and linkage to treatment to reduce the risk of liver-related morbidity and mortality.