Background & Aims: Hepatitis D virus (HDV) has decreased in Europe, but
recent reports indicate a rising trend. We report the epidemiological
changes, clinical progress, and effect of treatment on the natural
course of HDV infection in Greece during the last 13 years.
Methods: Prospective data were extracted from the Hep-Net. Greece
Cohort-Study.
Results: Since 1997, 4673 chronic HBV (CHB) cases (4527 adults, 146
children) have been followed prospectively. Two thousand one hundred
thirty-seven patients were tested for anti-HDV [101 (4.7%) positive].
Anti-HDV testing in Greece decreased significantly (57.0% before 2003,
35.3% thereafter; p < 0.001). Anti-HDV prevalence among HBsAg-positives
was 4.2%; lower in native Greeks (2.8%) than in immigrants (7.5%) or
in children (15.3%; p < 0.001). Within 2.3 years of follow-up, HDV
occurred in 11/2047 HBsAg-positive patients (2.2 new delta-infected
adults and 8.7 children per 1000 HBsAg-positive annually). HDV-positive
compared to CHB adults were younger (p = 0.035) and had more active and
advanced disease at baseline, as indicated by laboratory indices and the
higher prevalence of cirrhosis at younger age. During a 4.2-year median
observation, significantly more anti-HDV-positive than CHB adults
developed a liver-related first event (20.0% vs. 8.5%, p(Log-rank) =
0.014). Treatment was received by 46/90 (51.1%) patients, 40 of them
interferon-based. In multivariable analysis, interferon significantly
decreased disease progression in HDV-positive patients [HR = 0.14
(95% CI: 0.02-0.86; p = 0.033)].
Conclusions: In Greece, HDV serology is currently tested in only
one-third of HBsAg-positive patients. HDV prevalence is lower in native
Greeks compared to immigrants, who may contribute >50% of the HDV
infection burden in Greece. Data show that HDV infection is a rapidly
progressive disease, but interferon-based treatment may alter its
course. (C) 2013 European Association for the Study of the Liver.
Published by Elsevier B.V. All rights reserved
