BACKGROUND Chronic hepatitis delta is a severe liver disease with rapid progression to cirrhosis. The impact of hepatitis delta virus (HDV)-RNA on disease progression and interferon treatment in a real-world cohort has been barely explored. AIM To assess the development of clinical events in a cohort of chronic hepatitis delta patients according to the presence or absence of HDV-RNA METHODS: Multicentre study at four academic hospitals in Spain included anti-HDV-positive patients with compensated liver disease with a follow-up ≥12 months. RESULTS Among 2888 HBsAg-positive subjects, 151 (5.2%) tested positive for anti-HDV, and 118 were included (58% men; median age, 49 years; 73% detectable HDV-RNA and 30% cirrhosis, most often in subjects with HDV-RNA). After a median follow-up of 8 years, subjects with initially detectable HDV-RNA were more prone to developing cirrhosis (31% vs 0%, P = .002) and/or liver decompensation (28% vs 3%, P = .019). Mortality rate was 0.44 per 1000 person-months. The probability of a clinical event was 6%, 25%, and 80% according to initial baseline-event-anticipation score. HDV-RNA became undetectable in 21 (24%) subjects either due to interferon or spontaneously (48% vs 52%, P = .29). Liver decompensation was reduced in interferon-treated patients (13% vs 38%, P = .026). CONCLUSIONS Subjects with persistently positive HDV-RNA had a worse prognosis in terms of clinical events. Baseline-event-anticipation score is useful in predicting the risk of developing liver decompensation and hepatocellular carcinoma. Interferon was beneficial in reducing liver decompensation, even in the absence of virological response.

中文翻译：

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慢性丁型肝炎患者的长期临床结果：持续性病毒血症的作用。

背景慢性丁型肝炎是一种严重的肝脏疾病，会迅速发展为肝硬化。几乎没有探讨过真实世界队列中丁型肝炎病毒 (HDV)-RNA 对疾病进展和干扰素治疗的影响。目的 根据是否存在 HDV-RNA 评估一组慢性丁型肝炎患者临床事件的发展 方法：西班牙四家学术医院的多中心研究包括患有代偿性肝病的抗 HDV 阳性患者≥12 个月。结果 在 2888 名 HBsAg 阳性受试者中，151 名 (5.2%) 抗 HDV 检测呈阳性，包括 118 名（男性 58%；中位年龄 49 岁；73% 可检测到 HDV-RNA 和 30% 肝硬化，最常见于受试者与 HDV-RNA）。经过 8 年的中位随访，最初检测到 HDV-RNA 的受试者更容易发生肝硬化（31% 对 0%，P = .002）和/或肝脏失代偿（28% 对 3%，P = .019）。死亡率为每 1000 人月 0.44。根据初始基线事件预期评分，临床事件的概率为 6%、25% 和 80%。由于干扰素或自发（48% 对 52%，P = .29），HDV-RNA 在 21 (24%) 名受试者中检测不到。接受干扰素治疗的患者的肝脏失代偿减少（13% 对 38%，P = .026）。结论 就临床事件而言，HDV-RNA 持续阳性的受试者预后较差。基线事件预期评分可用于预测发生肝功能失代偿和肝细胞癌的风险。干扰素有利于减少肝脏失代偿，