High Rates of Advanced Chronic Liver Disease in Patients With Chronic Hepatitis D Virus Infection in Uzbekistan

BACKGROUND AND AIMS: Chronic hepatitis B virus (HBV) infection is endemic in Uzbekistan. Previous data showed a high prevalence of anti-hepatitis D virus (HDV) antibodies in HBsAg-positive individuals. Limited data are available on disease severity, treatment availability and hepatocellular carcinoma (HCC) prevalence in patients with chronic HDV infection in Uzbekistan. METHODS: The Scientific Research Institute of Virology (SRIoV) is the leading medical and scientific reference centre for viral hepatitis in Uzbekistan. In this retrospective study, epidemiological, clinical and laboratory data were collected and analysed from all HBsAg-positive patients presenting to the SRIoV between June 2023 and May 2024. Data from HDV-coinfected and HBV-monoinfected patients were compared. RESULTS: Data of 1393 individual patients were included. HDV coinfection was more prevalent than HBV-monoinfection (73.9% [n = 1030/1393]) vs. 26.1% [n = 363/1393]. HDV-infected patients were significantly younger (41.9 vs. 45.4, p < 0.001) and showed higher rates of cirrhosis (78.4% vs. 43.9%, p < 0.001) with the majority of patients being classified as Child-Pugh score B (57.8%). Only a minority of HDV-coinfected patients has ever received anti-HDV-directed treatment (0.4%, n = 4/1030). Consecutively, HDV RNA was detectable in 78.9% (812/1023) of patients. Quantitative HDV RNA was independently associated with ALT elevation > upper limit of normal. The HCC detection rate was low in both patient groups due to insufficient screening measures (HDV: n = 7/1030, HBV: n = 11/363). CONCLUSIONS: In this retrospective cohort of 1393 individual patients, HDV coinfection exceeds HBV monoinfection in prevalence and disease severity. Most HDV-infected patients present with advanced liver disease and currently lack access to HDV-directed therapy.