Abstract
BACKGROUND: Research on HDV prevalence among people with HBV/HIV coinfection in China is limited. The impact of HDV on antiretroviral therapy (ART) efficacy and liver disease progression in this population remains unclear. METHODS: This retrospective cohort study included people with HBV/HIV-1 between 2005 and 2022. Baseline plasma was tested for HDV IgM/IgG; HDV RNA was measured if antibodies were positive. Demographics, liver complications, and ART responses were compared by HDV status. RESULTS: Overall, 1130 people with HBV/HIV-1 were included, of whom 84 (7.4%) tested positive for HDV antibodies. Among these, 19 (22.6%) were HDV RNA-positive. Approximately 41.7% of HDV antibody-positive individuals had HCV coinfection. The median duration of ART was 7.4 years (interquartile range [IQR]: 5.1, 9.9). Longitudinal samples were available from 14 individuals with HDV RNA positivity. Baseline HDV RNA was 2.98 (IQR: 2.17, 4.78) log10 IU/mL. After a rapid decline during ART, 92.8% (13/14) of individuals reached undetectable levels at 7 years. When adjusted for HCV infection, HIV and HBV virological suppression, HBsAg clearance, and immunological nonresponders were comparable between HDV antibody-positive and -negative individuals (all P > .05), and between HDV RNA-positive and -negative individuals (all P > .05). The incidence rates of newly developed cirrhosis and hepatocellular carcinoma were also similar. CONCLUSIONS: HDV coinfection was observed in 7.4% of people with HBV/HIV-1, as a defective virus reliant on HBV, HDV RNA declined rapidly during long-term ART and HDV coinfection did not compromise HIV or HBV treatment efficacy.