# Prevalence and Risk Factors of Elevated Alanine Aminotransferase (ALT) in 2382 Treatment‐naïve HBV/HDV Co‐Infected Patients

## TL;DR

This study found that young adults with hepatitis D and B co-infection have higher liver enzyme levels and more severe disease compared to those with only hepatitis B.

## Contribution

The study identifies unique risk factors for elevated ALT in young hepatitis D/B co-infected patients compared to hepatitis B alone.

## Key findings

- 78.5% of CHD patients had elevated ALT, highest in 18-20 year olds.
- Young CHD patients had 8.2x higher odds of elevated ALT compared to matched CHB patients.
- ALT elevation in CHD was linked to younger age, elevated GGT, and HDV RNA levels.

## Abstract

Chronic hepatitis D (CHD) causes severe chronic hepatitis. Knowledge is limited about factors correlating with ALT in treatment‐naïve patients with CHD. This study analysed the pattern and determinants of ALT elevation in a large cohort of patients with CHD, including young adults, compared to propensity score‐matched (PSM) patients with chronic hepatitis B (CHB).

We identified 2382 treatment‐naïve HBsAg+ adults with CHD (HDV RNA positive) and 1553 with CHB attending a liver center in Mongolia during 2015–2023. The correlation between ALT levels, virological, biochemical, and fibrosis parameters was assessed using Spearman coefficient (rho). Logistic regression analysis was used to identify determinants of elevated ALT in 1371 PSM pairs with CHD and CHB matched on age, sex, metabolic factors, and date of initial test.

In CHD, 78.5% of patients had ALT elevation, with the highest prevalence in the 18–20 years group (n = 219, 84.5%). This age group displayed 8.2‐adjusted odds ratio (aOR) for elevated ALT, 2.7‐aOR for elevated GGT, and 4.5‐aOR of cirrhosis than matched CHB group (all p < 0.05). In CHD, ALT correlated weakly with HDV RNA (rho = 0.23) and liver stiffness (rho = 0.37), moderately with GGT (rho = 0.48), while showed no correlation with HBV DNA or HBsAg. Independent factors for elevated ALT were age < 30 years, elevated GGT and HDV RNA levels.

In this large cohort of Asian patients, an earlier and more severe inflammatory process could be demonstrated in CHD compared to CHB regardless of liver cirrhosis. Longitudinal studies are warranted to risk‐stratify and prioritise patients for therapies.

The prevalence and determinants of alanine aminotransferase (ALT) elevation were studied in a large cohort of 2382 treatment‐naïve patients with chronic hepatitis D (CHD) compared to 1553 with HBV mono‐infection.Young patients (< 30 years of age) with CHD showed more prevalent ALT elevation and HBeAg+ than propensity‐score matched peers with HBV mono‐infection.ALT elevation in CHD was independently associated with younger age, elevated GGT and HDV RNA levels.ALT elevation in young adults with CHD and HBeAg+ suggested a more aggressive and prolonged phase of immune response.

The prevalence and determinants of alanine aminotransferase (ALT) elevation were studied in a large cohort of 2382 treatment‐naïve patients with chronic hepatitis D (CHD) compared to 1553 with HBV mono‐infection.

Young patients (< 30 years of age) with CHD showed more prevalent ALT elevation and HBeAg+ than propensity‐score matched peers with HBV mono‐infection.

ALT elevation in CHD was independently associated with younger age, elevated GGT and HDV RNA levels.

ALT elevation in young adults with CHD and HBeAg+ suggested a more aggressive and prolonged phase of immune response.