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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
PubMed

Insights

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.
Abstract

Keywords:
chronic hepatitis Dcohort validationliver‐related outcomesquantitative HDV‐RNA

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