Author information

¹Department of Medicine, Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

²Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

³Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

⁴Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

⁵Department of Medicine, Division of Allergy and Infectious Disease, University of Washington School of Medicine, Seattle, Washington, USA.

⁶Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, California, USA.

⁷Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA.

⁸Department of Medicine, Division of Infectious Disease, University of Alabama, Birmingham, Alabama, USA.

⁹Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.

¹⁰Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA.

¹¹Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.

¹²The Fenway Institute, Fenway Health, Boston, Massachusetts, USA.

¹³Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA.

¹⁴Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.

¹⁵Department of Medicine, Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Abstract

Hepatitis delta virus (HDV) infection increases the risk of liver complications compared to hepatitis B virus (HBV) alone, particularly among persons with human immunodeficiency virus (HIV). However, no studies have evaluated the prevalence or determinants of HDV infection among people with HIV/HBV in the US. We performed a cross-sectional study among adults with HIV/HBV coinfection receiving care at eight sites within the Center for AIDS Research Network of Integrated Clinical Systems (CNICS) between 1996 and 2019. Among patients with available serum/plasma specimens, we selected the first specimen on or after their initial HBV qualifying test. All samples were tested for HDV IgG antibody and HDV RNA. Multivariable log-binomial generalized linear models were used to estimate prevalence ratios (PRs) with 95% CIs of HDV IgG antibody-positivity associated with determinants of interest (age, injection drug use [IDU], high-risk sexual behaviour). Among 597 adults with HIV/HBV coinfection in CNICS and available serum/plasma samples (median age, 43 years; 89.9% male; 52.8% Black; 42.4% White), 24/597 (4.0%; 95% CI, 2.4%-5.6%) were HDV IgG antibody-positive, and 10/596 (1.7%; 95% CI, 0.6%-2.7%) had detectable HDV RNA. In multivariable analysis, IDU was associated with exposure to HDV infection (adjusted PR = 2.50; 95% CI, 1.09-5.74). In conclusion, among a sample of adults with HIV/HBV coinfection in care in the US, 4.0% were HDV IgG antibody-positive, among whom 41.7% had detectable HDV RNA. History of IDU was associated with exposure to HDV infection. These findings emphasize the importance of HDV testing among persons with HIV/HBV coinfection, especially those with a history of IDU.