Prevalence and characteristics of Hepatitis delta virus infection in patients with hepatitis b in the united states: An analysis of the All-Payer Claims Database

Abstract

Background and Aims: Hepatitis delta virus (HDV) leads to the most severe form of viral hepatitis; however, the prevalence of HDV is not well understood. Using real-world data from the All-Payer Claims Database (APCD), this study estimates the prevalence of HBV/HDV infection among the chronic hepatitis B (HBV) population and describes patient/clinical characteristics for adults with HBV/HDV infection in the United States (US). Approach and Results: Adults (≥ 18 y) with ≥1 inpatient claim or ≥2 outpatient claims for HDV infection or HBV in the APCD from 1/1/2014 to 12/31/2020 were identified. HDV prevalence was calculated as the proportion of patients with HBV/HDV infection among total patients with HBV infection. Patient characteristics, socioeconomic status, advanced liver complications (e.g., cirrhosis, hepatocellular carcinoma), and comorbidities were assessed. A total of 6,719 -patients were diagnosed with HBV/HDV among 144,975 with HBV and 12-months of continuous data, for a prevalence of 4.6%. At diagnosis, 31.7% of patients with HBV/HDV had advanced liver complications, including compensated cirrhosis (16.3%) and decompensated cirrhosis (10.4%). Diabetes (50.5%), hypertension (49.8%), HIV infection (30.9%), were the top three comorbidities. Conclusion: In a large database capturing approximately 80% of the US insured population, HBV/HDV infection prevalence was 4.6% among HBV-infected adults. HDV-infected patients had high rates of baseline liver complications and other comorbidities at time of diagnosis, suggesting potentially delayed diagnosis and/or treatment. Earlier identification of HBV/HDV infection among the HBV population may provide opportunities to improve linkage to care and treatment, thereby reducing the risk of liver-related morbidity and mortality.