Progression to cirrhosis in chronic hepatitis D with mild-to-moderate fibrosis: Insights from a multicenter European cohort
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Le résumé fourni par la source
BACKGROUND & AIMS: Hepatitis delta virus (HDV) is the most aggressive form of chronic viral hepatitis. As new therapies emerge, a clearer understanding of its natural history - particularly in early disease stages - is needed. We assessed real-world outcomes of HDV-infected patients with mild-to-moderate fibrosis and identified predictors of progression to cirrhosis. METHODS: We performed a multicenter, international, retrospective study including adult patients with active HDV infection (HDV-RNA positive) and no advanced fibrosis at baseline, confirmed by histology or liver stiffness measurement (TE-LSM) within the first year of diagnosis. Demographic, clinical, biochemical, and virological variables were collected at baseline and annually thereafter. The primary outcome was development of cirrhosis; secondary outcomes included liver-related events and longitudinal changes in fibrosis markers. RESULTS: The cohort included 168 patients (median age 37.5 [31-45] years; 53% male; 56% Caucasian). Fewer than 15% had HIV/HCV coinfection or metabolic/alcohol-related risk factors. At baseline, 36% had ALT ≥2 × the upper limit of normal and median TE-LSM was 7.6 (6-9) kPa. Over a median follow-up of 62 (40-94) months, 37 patients (22%) developed cirrhosis. Two developed ascites (one required liver transplantation), and one developed hepatocellular carcinoma and died. HDV clearance occurred in 32 patients (19%), either spontaneously (n = 14) or after antiviral therapy (n = 18). In the multivariate analysis, only TE-LSM ≥7 kPa independently predicted progression (HR 6.02 [1.76-20.6]; p = 0.004). FIB-4 ≥1.45 also identified higher-risk patients when TE-LSM was unavailable (HR 3.51 [1.68-7.34]; p <0.01). Neither antiviral therapy nor changes on HDV RNA or ALT overtime remained as independent predictors. CONCLUSIONS: Despite mild-to-moderate baseline fibrosis, over 20% of patients progressed to cirrhosis within 5 years. Baseline non-invasive markers effectively stratify risk and may inform prioritization of emerging HDV therapies. IMPACT AND IMPLICATIONS: Patients with HDV and mild-to-moderate fibrosis remain at substantial risk of progression, with more than 20% developing cirrhosis during a median follow-up of 5 years. Liver stiffness measured by transient elastography (TE-LSM) was the strongest predictor of progression. FIB-4 may have a prognostic value when TE-LSM is not available, whereas ALT levels and HDV-RNA, both at baseline and during follow-up, did not influence fibrosis outcomes. These findings support improved early risk stratification and may help clinicians identify which patients with apparently early-stage disease warrant closer monitoring or timely treatment intervention.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Progression to cirrhosis in chronic hepatitis D with mild-to-moderate fibrosis: Insights from a multicenter European cohort
- Date Crossref
- 01/08/2026
- Éditeur
- Elsevier BV
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Karolinska University Hospital Department of Infectious Diseases pays non établi dans la noticeÉtablissement de santé
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Hospital Clínic de Barcelona pays non établi dans la noticeÉtablissement de santé
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University of Antwerp Laboratory of Experimental Medicine and Pediatrics pays non établi dans la noticeUniversité ou école supérieure
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University of Padua pays non établi dans la noticeUniversité ou école supérieure
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Azienda Ospedale - Università Padova pays non établi dans la noticeÉtablissement de santé
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Université Sorbonne Paris Nord Department of Microbiology pays non établi dans la noticeUniversité ou école supérieure
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Hôpital Avicenne pays non établi dans la noticeÉtablissement de santé
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National and Kapodistrian University of Athens Academic Department of Gastroenterology pays non établi dans la noticeUniversité ou école supérieure
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Laiko General Hospital of Athens pays non établi dans la noticeÉtablissement de santé
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Universitat Autònoma de Barcelona pays non établi dans la noticeUniversité ou école supérieure
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Vall d'Hebron Hospital Universitari pays non établi dans la noticeÉtablissement de santé
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Complejo Hospitalario Torrecárdenas pays non établi dans la noticeÉtablissement de santé
Department of Infectious Diseases — Karolinska University Hospital, Hospital Clínic de Barcelona et Laboratory of Experimental Medicine and Pediatrics — University of Antwerp, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.