Distinct histological patterns in chronic hepatitis D with nucleos(t)ide analogue therapy

Area of Science:

• Hepatology
• Virology
• Pathology

Background:

• Chronic hepatitis delta virus (HDV) infection causes more severe liver disease than hepatitis B virus (HBV) alone.
• Histological staining patterns in HBV mono-infection are known, but less studied in HDV co-infection.
• The impact of nucleos(t)ide analog (NA) therapy on HBV in HDV co-infection requires further investigation.

Purpose of the Study:

• To evaluate the effect of nucleos(t)ide analog (NA) therapy for concurrent hepatitis B virus (HBV) infection on the histological appearance of chronic hepatitis delta virus (HDV).

Main Methods:

• Retrospective review of liver biopsies from patients with HDV infection.
• Evaluation of hepatitis-specific stains for HBV antigens.
• Comparison of clinical and histological features between patients on and off NA therapy.

Main Results:

• Fifty patients were analyzed; 26 (52%) were on NA therapy.
• Patients on NA therapy showed a significantly higher odds ratio for membranous staining (7.15) compared to those off NA therapy (0.13).
• Membranous staining was associated with lower total inflammation scores, but not with markers of disease severity or viral activity.

Conclusions:

• Nucleos(t)ide analog treatment in chronic HDV infection is associated with a unique membranous hepatitis B surface antigen staining pattern.
• This histological pattern is independent of HBV or HDV replicative activity.
• Findings enhance understanding of HBV-directed therapy's role in HDV pathophysiology.