P2873 - Comparative Analysis of Clinical Outcomes in Hepatitis B/Delta Virus Co-infection vs Hepatitis B Mono-Infection in a Large Integrated Healthcare System

Xiaoran Li, MD¹, Lue-Yen Tucker, BA², Krisna P. Chai, MD³, Suk Seo, ⁴, Nizar Mukhtar, MD¹, Grace M. Chee, PharmD⁵, Kyung Kwon, MD⁶, Sripriya Balasubramanian, MD, MPH⁷, Brock Macdonald, MD⁸, Julie Schmittdiel, PhD, MA², Varun Saxena, MD, MAS^9
1Kaiser Permanente, San Francisco, CA; ²Kaiser Permanente, Pleasanton, CA; ³Kaiser Permanente, Santa Clara, CA; ⁴Kaiser Permanente, Moraga, CA; ⁵Gilead Sciences, Inc., Foster City, CA; ⁶Gilead Sciences, Inc., Gilead, CA; ⁷Kaiser Permanente, Roseville, CA; ⁸Kaiser Permanente, San Rafael, CA; ⁹Kaiser Permanente, South San Francisco, CA

Introduction: Clinical observation has suggested Hepatitis B virus (HBV)/Hepatitis Delta virus (HDV) co-infection may lead to worse prognosis compared to HBV mono-infection. However, conclusive evidence of poorer outcomes in HBV/HDV co-infected patients remains elusive due to under-estimation of HBV/HDV co-infection stemming from low HDV screening rates. In this study, we aim to compare clinical outcomes of patients with HBV/HDV co-infection vs. HBV mono-infection in a large integrated healthcare system, underscoring the importance of routine HDV screening and necessity for tailored therapeutic interventions.

Methods: In this retrospective cohort study at Kaiser Permanente Northern California, all adult HBV-infected patients identified between 2009 and 2021 were included. Two study groups were identified: HBV/HDV co-infected (anti-HDV positive with/without HDV RNA tested/detected) and HBV mono-infected (HBV surface antigen positive; anti-HDV negative or never checked). Both groups were followed until the occurrence of outcomes of interest (cirrhosis, hepatocellular carcinoma [HCC], liver transplant, and all-cause mortality), membership loss, or study conclusion on December 31, 2022. Patient characteristics and outcomes were compared between the two groups. Kaplan-Meier survival analysis was used to estimate the cumulative incidence of the outcome; the multivariable Cox proportional-hazards model was utilized to assess association between risk factors and the outcome.

Results: Final cohort included 94 HBV/HDV co-infected and 17700 HBV mono-infected patients. The median ages were 58 and 48 years, the body mass index 26.4 and 24.7, and the baseline MELD scores 8.0 and 7.0 in the HBV/HDV co-infected group and HBV mono-infected group, respectively. HBV/HDV co-infection was associated with higher incidences of cirrhosis, HCC, and liver transplant (Figure 1). While all-cause mortality rates were elevated beyond year 4 in HBV/HDV co-infected patients, statistical significance was not reached. When controlling for demographic factors and medical conditions, HBV/HDV (vs. HBV mono-infected) was an independent risk factor for HCC and liver transplant but not cirrhosis or all-cause mortality (Table 1).

Discussion: This study demonstrated HBV/HDV co-infection is associated with poorer clinical outcomes within a large integrated healthcare system. Our study highlights the importance of routine HDV screening and the need for tailored therapeutic interventions.



Disclosures:


Xiaoran Li, MD¹, Lue-Yen Tucker, BA², Krisna P. Chai, MD³, Suk Seo, ⁴, Nizar Mukhtar, MD¹, Grace M. Chee, PharmD⁵, Kyung Kwon, MD⁶, Sripriya Balasubramanian, MD, MPH⁷, Brock Macdonald, MD⁸, Julie Schmittdiel, PhD, MA², Varun Saxena, MD, MAS⁹. P2873 - Comparative Analysis of Clinical Outcomes in Hepatitis B/Delta Virus Co-infection vs Hepatitis B Mono-Infection in a Large Integrated Healthcare System, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.