Chronic hepatitis D in Austria: high burden of cirrhosis and portal hypertension, IL28B C/C as unfavorable factor, increased systemic inflammation in decompensation

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INTRODUCTION: Chronic hepatitis D (CHD) is a severe viral hepatitis characterized by a rapid progression towards advanced chronic liver disease (ACLD). This study aimed to characterize the Austrian CHD epidemiology with respect to disease severity, systemic inflammation and genetic markers. METHODS: Patients attending one of six participating hospitals from 2020 onwards were included and assessed regarding laboratory data, liver stiffness measurement (LSM) and biopsy, hepatic venous pressure gradient (HVPG) measurement, endoscopy and imaging. In a subset, single nucleotide polymorphisms (SNPs) in genes of interest (IL28B, PNPLA3, SERPINA1, NTCP) were assessed. Biomarkers of liver disease severity were compared to an age-matched cohort of treatment-eligible and treatment-naïve chronic hepatitis B (CHB) patients. RESULTS: A total of 59 CHD patients (median age: 44.0 years, 59.3% male) were included and ACLD was found in 62.7%. Decompensated patients exhibited higher levels of biomarkers of systemic inflammation, such as C‑reactive protein (p = 0.061) and interleukin 6 (p = 0.008). The SNP IL28B C/C genotype had an unfavorable effect on disease severity (higher Model for End-Stage Liver Disease [MELD] score, HVPG and ammonia levels, lower platelet counts and albumin levels, all p < 0.05). The CHD patients showed a more severe liver disease compared to CHB mono-infected patients with respect to LSM, platelets, MELD and portal hypertension (all p < 0.01). CONCLUSION: This analysis of the Austrian CHD cohort before initiation of antiviral treatment showed a high burden of ACLD and portal hypertension, especially when compared to CHB patients. The IL28B C/C SNP was associated with a more severe liver disease in CHD.

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