# Clinical Evaluation of the Progression of Liver Disease in Patients Coinfected With HBV and HDV in the Western Amazon Region of Brazil

## TL;DR

This study compares liver disease progression in patients coinfected with HBV and HDV versus those with only HBV in Brazil's Western Amazon region.

## Contribution

It provides new clinical evidence that HDV coinfected patients show more severe liver disease progression than HBV monoinfected individuals in this region.

## Key findings

- Over 40% of HDV-infected patients showed signs of advanced liver fibrosis compared to 5%-10% in HBV monoinfected patients.
- 45.5% of HDV-infected patients already had advanced liver disease at enrollment.
- HDV coinfected patients exhibited more severe liver disease characteristics across all evaluated parameters.

## Abstract

Background: Worldwide, an estimated 296 million individuals are chronic carriers of hepatitis B virus (HBV), with approximately 5% also coinfected with hepatitis delta virus (HDV). In Brazil, HBV and HDV are endemic in the states of the Western Amazon. This study is aimed at characterizing a cohort of patients coinfected with HBV and HDV and comparing their clinical and epidemiological profiles with those of HBV monoinfected individuals.

Methods: The study involved a retrospective clinical analysis of individuals monoinfected with HBV and coinfected with HDV, conducted between 2017 and 2018 in Rondônia, Brazil.

Results: A total of 324 patients were enrolled in the study, comprising 302 individuals with HBV monoinfection and 22 with HBV–HDV coinfection. Patients with HDV exhibited significantly more clinical signs of advanced liver disease. Using APRI and FIB-4 scores with cut-off values established for HBV, over 40% of HDV-infected patients had values indicative of advanced liver fibrosis, compared to 5%–10% in the HBV monoinfected group. Across all evaluated parameters of liver disease, HDV patients displayed more severe characteristics, with 45.5% already showing signs of advanced liver disease at the time of enrollment.

Conclusion: Our study underscores the importance of the clinical analysis of hepatitis delta as a more aggressive disease model compared to hepatitis B in the population of the Western Brazilian Amazon, highlighting its significance as a public health concern in the region.