# Hepatitis D virus infection prevalence in persons with human immunodeficiency virus and hepatitis B virus coinfection in Germany

## TL;DR

This study finds that 7% of people with HIV and hepatitis B in Germany have hepatitis D antibodies, but only half show active infection.

## Contribution

The study provides the first data on HDV prevalence among HIV/HBV coinfected individuals in Germany.

## Key findings

- 7.3% of participants had HDV antibodies indicating past or current infection.
- Only 58% of those with HDV antibodies had active HDV replication.
- Most participants were on effective antiviral therapy for HIV and HBV.

## Abstract

People with HIV (PWH) who have chronic hepatitis B virus (HBV) coinfection are at increased risk of also having hepatitis D virus (HDV) infection given the shared transmission pathways. The current prevalence of HDV in Germany among people with HIV/HBV, however, is unknown. The aim of this study was to determine the percent with HDV screening as well as the current HDV prevalence among German PWH with HBV coinfection and underlying risk factors for HDV infection.

21 German HIV treatment centers (6 university clinics, 15 private practices) recruited all people with a confirmed HIV diagnosis and a positive hepatitis B surface antigen for more than 6 months, aged ≥ 18 years, and actively in care on December 31, 2023. We assessed the percent with anti-HDV antibody testing in the total cohort. In addition, we calculated the prevalence of individuals who ever had an anti-HDV positive serology (i.e., past/current infection) and the prevalence of individuals whose last HDV RNA result was positive (i.e., active infection).

Overall, 458 PWH with HBV coinfection were included in the analysis. 17% of the participants were female and 83% male. Median age was 55 years (IQR 48–61). 99% of participants were receiving antiviral dual active therapy with 84% having undetectable HIV viral load and 90.8% having undetectable HBV-DNA. Anti-HDV antibody results were available in 370 (81%). Of these, 27 (7.3%) had a previous/current HDV infection. HDV RNA testing was performed in 24/27 participants with HDV-positive serology, of whom 14/24 (58%) were positive.

In Germany, 7% of PWH with HBV coinfection who underwent HDV screening had HDV antibodies with only half showing signs of active HDV replication.