The natural history of hepatitis D virus infection in Illinois state facilities for the developmentally disabled

We sought to define the natural history of hepatitis D virus infection in an institutionalized, developmentally disabled population and to identify other prognostic factors.

A retrospective cohort study was conducted on 231 hepatitis B virus carriers, 65 of whom were also infected with hepatitis D virus, at thirteen Illinois state facilities for the developmentally disabled. Demographic, clinical and laboratory data from 1986 to 1998 were obtained by chart review. Cox regression analysis was used to compare those with and without hepatitis D virus infection in terms of overall mortality, mortality from hepatic disease, and risk of developing chronic hepatitis and cirrhosis and to identify other potential prognostic factors.

Residents with hepatitis D virus infection were more likely to die of liver disease than uninfected residents (11% vs 0.6%, respectively; relative hazard, 15.2; 95% confidence interval, 1.8-126.6), although there was no significant difference in overall mortality. Twenty-one percent of residents with hepatitis D virus infection were diagnosed to have cirrhosis or chronic hepatitis compared with 9% of those uninfected (relative hazard 2.5, 95% confidence interval 1.2-5.2). Among the other variables tested, none was predictive of risk of dying of liver disease, and only seropositivity for hepatitis B e antigen was predictive of risk of developing cirrhosis or chronic hepatitis.

In an institutionalized, developmentally disabled population of hepatitis B virus carriers, hepatitis D virus infection is associated with a greater risk of liver-associated mortality and of developing chronic liver disease than that associated with hepatitis B virus carriage alone.