Characteristics and outcome of anti-hepatitis D virus positive patients with hepatocellular carcinoma

Area of Science:

• Hepatology
• Viral Hepatitis
• Oncology

Background:

• Chronic hepatitis D virus (HDV) infection is a significant risk factor for end-stage liver disease and hepatocellular carcinoma (HCC).
• Limited data exists on the characteristics, management, and outcomes of patients with concurrent HDV and HCC.
• Hepatitis B virus (HBV) infection alone also poses risks for liver disease and HCC.

Purpose of the Study:

• To assess the clinical and oncological characteristics of patients with co-infection of HDV and HBV (HBV/HDV).
• To compare the management strategies and survival outcomes between HBV/HDV patients and those with HBV infection alone.
• To identify differences in HCC diagnosis, staging, and treatment modalities between the two groups.

Main Methods:

• Analysis of the Italian Liver Cancer database.
• Inclusion of 107 patients with HBV/HDV co-infection and 588 patients with HBV infection alone.
• Comparison of clinical, oncological, treatment, and survival data between the groups.

Main Results:

• HBV/HDV patients exhibited significantly worse liver function (MELD and Child-Turcotte-Pugh scores) compared to HBV patients.
• Hepatocellular carcinoma (HCC) was diagnosed more frequently during surveillance in HBV/HDV patients (72.9% vs. 52.4%) and at an earlier stage (Milan criteria: 67.3% vs. 52.7%).
• Liver transplantation was more common in HBV/HDV patients (36.4% vs. 9.5%), with a higher probability of receiving the transplant, while resection was less frequent (8.4% vs. 20.1%).

Conclusions:

• Hepatocellular carcinoma (HCC) in patients with hepatitis D virus (HDV) and hepatitis B virus (HBV) co-infection is often detected earlier through surveillance, presenting at a less advanced stage.
• Patients with HBV/HDV co-infection demonstrate a significant benefit from liver transplantation, which positively impacts survival rates.
• These findings highlight the importance of surveillance and the role of liver transplantation in managing HCC in the context of HDV/HBV co-infection.