Vibration-Controlled Transient Elastography for the Detection of Cirrhosis in Chronic Hepatitis D Infection

Abstract

Non-invasive detection of cirrhosis via vibration-controlled transient elastography (VCTE) has revolutionized the management of chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. However, VCTE has not been studied in chronic hepatitis D virus (HDV) infection and accuracy remains in question due to the significant hepatic inflammation associated with this infection. Consecutive HBV, HCV, and HDV patients who underwent VCTE (2006–2019) were evaluated. Diagnosis of cirrhosis was made via liver biopsy or clinical findings. VCTE was compared to other non-invasive serum fibrosis tests using AUROC curves. The performance of VCTE in HBV/HCV/HDV was also compared. We evaluated 319 patients (HBV-112; HCV-132; HDV-75), 278(87%) patients had histology for evaluation. HDV patients had evidence of higher hepatic inflammation as evidence by aspartate aminotransferase, alanine aminotransferase, and histology activity index. Cirrhotic HDV patients had higher mean liver stiffness measurements compared to non-cirrhotic patients (29.0 vs 8.3 kPa, P<0.0001). VCTE demonstrated excellent diagnostic accuracy for the detection of cirrhosis with an AUROC of 0.90 compared to APRI (0.83), FIB-4 (0.88), AAR (0.73), and RPR (0.85). Performance of VCTE in HDV was comparable to HBV (0.93) and HCV (0.94). At the optimized cut-off value of ≥14.0 kPa for determining cirrhosis in HDV, VCTE had a sensitivity of 0.78, specificity of 0.86, NPV of 0.93, and PPV of 0.64. Hence VCTE is a useful non-invasive test in HDV for determining cirrhosis despite the presence of significant hepatic inflammation.