Infection with hepatitis D virus (HDV) is not common among patients receiving oral nucleotide/nucleoside analogues for chronic hepatitis B (CHB) infection, according to results of a study published in the Journal of Gastroenterology and Hepatology.

HDV is a single strand RNA virus that relies on hepatitis B virus (HBV) for its replication, thus HDV may coinfect with HBV concurrently, or superinfect a patient with existing HBV infection. However, the seroprevalence of HDV has become rare since the start of universal HBV vaccination.

Therefore, researchers sought to determine the seroprevalence and clinical course of HDV in a large HBV cohort (n=2850) in Taiwan who had received oral antiviral therapy. They found that 2.7% of hospital-based patients with CHB who received nucleotide/nucleoside analogues were seropositive for anti-HDV, of which, 37.1% had HDV viremia at the time of initiating therapy with nucleotide/nucleoside analogues.

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Factors inversely associated with anti-HDV seropositivity were platelet counts, HBV DNA levels, and hepatitis B e-antigen (HBeAg) seropositivity. Age was the only factor negatively associated with HDV RNA seropositivity; patients with HDV viremia were significantly younger than the non-viremic patients (52.3 years vs 58.5 years, respectively, P=.03). Seroclearance of anti-HDV and HDV RNA occurred with annual incidence of 3.0% and 4.3%, respectively. Patients with a baseline HDV titer < 0.5 cut-off index had a 30-fold chance of anti-HDV seroclearance (P = .001). No factors were found to be related to HDV RNA seroclearance and therapy with nucleotide/nucleoside analogues appeared to have no effect on seroclearance of anti-HDV and HDV RNA.

“In conclusion, HDV infection was not common in an [nucleotide/nucleoside analogues–treated cohort of active chronic hepatitis B in Taiwan,” stated the study authors. They added that, “Seroclearance of HDV seromarkers was not frequent and not related to [nucleotide/nucleoside analogues] therapy.”

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Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Jang TY, Wei YJ, Hsu CT, et al. Serial serologic changes of hepatitis D virus in chronic hepatitis B patients receiving nucleos(t)ides analogues therapy [published online April 4, 2020]. J Gastroenterol Hepatol. doi:10.1111/jgh.15061