Hepatitis Delta in Spain: A Nationwide Prospective Characterization of Active Infection and Liver Disease Severity.
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Alberola Ana, de Salazar Adolfo, Fuentes Ana, Carracedo Raquel, Cabezas Teresa, Viciana Isabel, Borrego Jaime, FrancoÁlvarez de Luna Francisco, Pérez Ana Belén, Algarate Sonia, Fraile-Ribot Pablo A, Ocete María Dolores, Fortuño María Gil, Illescas-López Marta, Lara Magdalena, Pena María José, Rodríguez-Fernández Ana, Praetorius Alejandro González, Lorenzo Belén, Vidal-Acuña María Reyes, Pérez-Rodríguez Lucía, Vázquez-Blanquiño Alberto, Blasco Miriam, Falces-Romero Iker, Romero-Hernández Beatriz, Alonso Roberto, Iborra Asunción, Miqueleiz Ana, Elorduy Luis, González Carmen Gómez, Arenzana Paloma Liendo, Salicio Yolanda, Aguilera Antonio, García Federico, DDR Spain Study Group
Аннотация
METHODS: This nationwide, multicentre, prospective observational study included adults with positive anti-HDV serology enrolled between April 2024 and March 2026 across 72 hospitals in 15 Spanish Autonomous Communities. Demographic, virological, laboratory and clinical data were collected in a centralized database. Multivariable logistic regression was used to identify factors independently associated with active HDV infection and advanced liver fibrosis.
RESULTS: Among 1,112 anti-HDV-positive individuals, 670/1,112 (60%) were male, median age was 54 years (IQR 43-61), and 457/926 (49%) were born in Spain. HIV co-infection and anti-HCV positivity were present in 189/944 (20%) and 217/1,112 (21%), respectively. HDV-RNA was detectable in 436/1,047 patients (42%), with a median viral load of 4.1 log IU/mL (IQR 2.9-5.1). Genotype 1 accounted for 108/121 (89%) genotyped infections. Advanced fibrosis was present in 222/536 (41%) evaluable patients and was more frequent in those with active infection than in non-viremic individuals (155/261, 59% versus 59/256, 23%; p<0.001). Active HDV infection was independently associated with younger age, hepatitis B virus (HBV) antiviral therapy, lower platelet count and lower albumin levels, whereas African origin was associated with lower odds of detectable HDV-RNA. Advanced fibrosis was independently associated with active HDV infection, HBV antiviral therapy and higher gamma-glutamyltransferase levels, while higher platelet count and haemoglobin levels were associated with lower odds of advanced fibrosis.
CONCLUSIONS: Active HDV infection and advanced liver disease remain common in Spain. These findings support systematic HDV-RNA testing, standardized fibrosis assessment and close clinical follow-up of anti-HDV-positive individuals.