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Baseline HDV-RNA Levels Could Stratify Clinical Risk Before, But Not After, Cirrhosis in Chronic Hepatitis D: A
Adriana Palom1,2, Elisabetta Degasperi3, Barbara Coco4
1Liver Unit, Hospital Univesitari Vall d'Hebron, Barcelona, Spain.
Alimentary Pharmacology & Therapeutics
|April 21, 2026
Summary
Quantitative hepatitis D virus RNA (HDV-RNA) levels predict liver disease progression in untreated chronic hepatitis D patients before cirrhosis develops. Post-cirrhosis, viral load is less critical for outcomes.
Area of Science:
- Hepatology
- Virology
- Clinical Prognostics
Background:
- Chronic hepatitis D (CHD) accelerates liver cirrhosis.
- Prognostic value of quantitative serum HDV-RNA in CHD is not fully understood.
Purpose of the Study:
- To assess if baseline HDV-RNA levels predict liver-related events in untreated CHD patients.
- To validate findings in independent European cohorts.
Main Methods:
- Multicenter retrospective-prospective cohort study.
- 260 untreated adults with CHD and detectable HDV-RNA.
- Baseline serum qHDV-RNA categorized in 1-log increments.
Main Results:
- 74 patients (28%) experienced liver-related events over 4.1 years.
- In non-cirrhotic patients, higher baseline HDV-RNA correlated with increased events.
- In cirrhotic patients, baseline HDV-RNA did not associate with outcomes.
Conclusions:
- Baseline quantitative HDV-RNA aids early risk stratification in non-cirrhotic CHD.
- Clinical outcomes in established cirrhosis are less dependent on viral replication.
- Prioritizing early antiviral intervention and surveillance is crucial.
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