Retrospective study investigation of the effectiveness of oral antiviral use in chronic HDV infection

ABSTRACT Aim: Hepatitis D is the most serious form of chronic viral hepatitis in humans. HDV, a defective RNA virus, requires HBV to replicate; therefore, it occurs only in HBV-infected individuals. HDV infection is characterized by a more rapid development of fibrosis than hepatitis B monoinfection, meaning that the risk of cirrhosis, cirrhotic decompensation and hepatocellular cancer is increased. The serious complications of HDV highlight the importance of careful monitoring and treatment of the disease. Treatment options include interferon and oral antivirals. Studies have shown the effectiveness of interferon therapy. The aim of the study was to investigate the effectiveness of different oral antiviral treatment regimens in patients with chronic HDV infection. It was also aimed to examine the effect of prognostic factors on survival in patients with chronic HDV infection. Materials and Methods: The study included 86 patients over the age of 18 who were diagnosed with Chronic HDV Infection and treated at Dicle University Faculty of Medicine Hospital Gastroenterology outpatient clinic between 01.01.2012 and 28.09.2023. The patients' files were examined retrospectively. The inclusion criteria for the study were based on patients who were older than 18 years of age at the time of application, had HBsAg +, antiDelta +, HBV DNA and/or HDV RNA +, and AST ALT above the upper normal limit. Initially, patients with HCC, anti-HCV infection, HIV infection, and patients using alcohol were excluded from the study. Findings: The average age of the patients is 51.0± 12.8 years. It was determined that 34 of the 86 patients were female (39.5%) and 52 were male (60.5%) (Female/Male ratio: 2/3). There is male dominance in our patient group. It was determined that 17 (19.8%) of the patients underwent liver transplantation during the follow-up period. It was determined that 15.1% of the patients died during the follow-up period. The causes of death were determined to be 14% hepatic and 1.1% non-hepatic, respectively. 53.5% of the patients were admitted due to chronic delta hepatitis and 30.2% due to compensated cirrhosis. 50 of the patients (58.1%) received only oral antiviral, 36 (41.9%) received oral antiviral + IFNα. has been determined to use . It was determined that variceal bleeding developed in 48.8% of the patients, ascites in 41.9%, hepatitis encephalopathy in 12.8%, HCC in 18.6%, and decompensation in 22.1%. A statistically significant difference was found between FIB-4 values according to the mortality status of the patients (p<0.05). It was found that the FIB-4 indexes of surviving patients were lower than those of deceased patients. A significant difference was found between the rates of variceal bleeding (p<0.05), ascites, hepatitis encephalopathy, HCC and decompensation development according to the mortality status of the patients (p<0.001). It has been determined that the rates of development of variceal bleeding, ascites, hepatitis encephalopathy, HCC and decompensation in ex patients are higher than in surviving patients. A significant difference was found between the fasting blood sugar values of the patients according to their mortality status (p <0.05). It was determined that the fasting blood sugar values of surviving patients were lower than those of deceased patients. A significant difference was found between INR values according to the mortality status of the patients (p<0.05). It was determined that the INR values of surviving patients were lower than those who were dea A significant difference was found between the patients' admission to the hospital according to their mortality status (X2=6.116; p<0.05). Surviving patients are more likely to be admitted to the hospital with chronic delta hepatitis than deceased patients; It was found that the rates of admission with compensated cirrhosis were lower than those with ex. There was no significant difference between the treatment responses of the patients according to the treatment status they received (p>0.05). There was no significant difference between patients receiving monotherapy and combination therapy in terms of treatment response and distribution of complications (p>0.05). Compared to those who did not use lamivudine, it was 3.773 times (OR: 3.773; p<0.05), 6.357 times (OR: 6.357; p<0.05) compared to those who did not have varicose bleeding, and 104.435 times (OR: 104.435; p<0.05) compared to those who did not have ascites. 0.001), 17.954 times greater than those without hepatic encephalopathy (OR:17.954; p<0.001), 7.724 times higher than those without HCC (OR:7.724; p<0.001), 14.244 times higher than those without decompensation (OR:14.244; p<0.001), and a one-unit increase in fasting plasma glucose value was 1.029 times higher than those without decompensation. fold (OR:1.029; p<0.05) It has been determined that there is a risk of mortality. A statistically significant difference was found in the overall survival rate between patients with variceal bleeding and patients without variceal bleeding (LogRank:7.662; p<0.05). It has been determined that the overall survival rate of those with varicose bleeding is lower than those without varicose bleedin. A statistically significant difference was found in the overall survival rate between patients with ascites and patients without ascites (LogRank: 19.317; p<0.001). It was determined that the overall survival rate of those with ascites was lower than those without ascites. A statistically significant difference was found in the overall survival rate between patients with ALP values below 91 U/L and patients with ALP values of 91 U/L and above (LogRank:5.078; p<0.05). It has been determined that the overall survival rate of those with ALP values below 91 U/L is higher than those with ALP values of 91 U/L and above. Results: In patients with chronic HDV infection, no significant difference was found between patients receiving oral antiviral monotherapy and patients receiving oral antiviral + interferon combination therapy in terms of treatment response and distribution of complications (p>0.05). It has been observed that OAV treatment is no different from IFN treatment in the treatment of Delta hepatitis. OAV therapy has an important place in the treatment of Delta hepatitis and can be used together with IFN therapy. Delta hepatitis is rare but still an important health problem in our region due to its rapid and poor course, and routine screening is required to recognize HDV infection. Contrary to the literature, our study is a study that will emphasize that oral antivirals should be given more importance in the treatment of HDV.