Hepatitis D Is an Important Cause of Decompensation in HBV Related Chronic Liver Disease in India

Abstract

Purpose: To study the extrinsic causes and methods of decompensation in hepatitis B related chronic liver disease. Methods: 78 patients of CLD-B; 13 compensated and 65 recently (< 3 months) decompensated were included. ACLF was defined as acute deterioration in liver function over a period of 2–4 weeks in a pre-existing patient of CLD. Patients with alcohol intake > 20 g/day, concomitant HCC, chronic liver disease due other causes, HIV positivity or severe co-morbid conditions were excluded. Serological tests including IgM anti HAV, IgM anti HEV, HBsAg, HBeAg, Anti HBe, IgM anti HBc, Anti -HCV, IgM Anti-delta, HIV 1&2. HBV DNA was quantified. Results: 68 patients were followed-up; 56 were ACLF and 12 were compensated liver disease. Patients with ACLF presented alone or in combination as jaundice, ascites or variceal bleed in 78%, 61% and 11% patients respectively. ACLF patients had higher AST, ALT, bilirubin, CPT score and lower serum albumin than compensated CLD patients. IgM anti HBc was significantly higher in ACLD (p < 0.001) but median HBV DNA was comparable to compensated CLD patients {(12 (0.5–1129) vs. 1.7 (0.5–3809) pg/ml)}. The most common extrinsic causes of decompensation were Hepatitis E in 17.8% of patients followed by Hepatitis D in 14.2% cases. Hepatitis A in 3.5% and Hepatitis C in 1.8% were other minor causes of decompensation. Reactivation of HBV was the cause in about 63% patients. Conclusions: Besides reactivation of HBV, and superinfection by Hepatitis E, Hepatitis D infection is an important cause of recent decompensation and acute-on chronic liver failure in India.