IN the era of tenofovir-based antiretroviral therapy (ART), HBV-coinfected people with HIV (PWH) remain at significant risk for hepatitis D virus (HDV) superinfection and liver-related mortality, according to a recent study spanning 12 years.
The research evaluated 534 HBV-coinfected PWH between 2011 and 2022, following patients until December 2023. Anti-HDV antibody testing of archived blood samples revealed that 6.7% of participants were HDV-seropositive at baseline. Among 498 initially HDV-negative participants, 10.0% seroconverted during the study period, with an incidence rate of 12.54 per 1,000 person-years of follow-up (PYFU). Notably, 88% of seroconverters were men who have sex with men.
While tenofovir-containing ART was administered for over 84% of the median 10.2-year follow-up period, HDV superinfection had a pronounced impact on liver-related health. HDV-infected individuals showed significantly higher rates of liver-related mortality (3.5% vs. 0.4%), cirrhosis (11.3% vs. 3.6%), and hepatitis flares (28.2% vs. 14.2%) compared to those without HDV infection.
Multivariate Cox regression analysis revealed a strong association between HDV infection and liver-related mortality, with an adjusted hazard ratio of 9.696 (95% CI, 1.284-73.222, P = .028). Interestingly, the risk of hepatocellular carcinoma was similar in HDV-infected and uninfected groups.
These findings underscore the ongoing vulnerability of HBV-coinfected PWH to HDV superinfection, despite advancements in ART. Clinicians should prioritize regular HDV screening for at-risk populations and maintain vigilance for liver-related complications.
This research highlights the critical need for improved prevention and management strategies to address the clinical burden of HDV infection among HBV-coinfected PWH.
Reference: Huang YS et al. Incidence and outcome of hepatitis D virus infection in people with HIV in the era of tenofovir-containing antiretroviral therapy. Clin Infect Dis. 2025;ciae655.
Anaya Malik | AMJ
