Delta virus infection in Jerusalem

The role of hepatitis delta virus (HDV) infection was analyzed retrospectively in a highly selected population of 76 patients who were hospitalized in Jerusalem for hepatitis B surface antigen positive for chronic active hepatitis and cirrhosis. Of 25 patients in whom serum and liver tissue were available, 5 patients (20%) showed evidence for HDV infection using a serum anti-HDV IgG radioimmunoassay; in one of them, HDV was also detected in nuclei of infected hepatocytes by immunofluorescence (IF). When only serum was tested, 12 of 45 patients (27%) were anti-HDV IgG positive. The use of IF alone had a very low yield of HDV detection. All HDV-positive patients with available serum had superinfection with the delta agent as confirmed by a negative anti-HBc IgM assay. The majority of HDV-positive patients were immigrants from Rumanian or Middle Eastern and Mediterranean origin. The mean age of delta-positive patients was 10 years lower at clinical presentation as compared with HDV-negative patients. HDV-positive patients had a higher mortality as compared with the HDV-negative group. In conclusion, HDV infection is prevalent among Israeli patients with chronic liver disease and persistent hepatitis B virus infection and leads to a significant morbidity and mortality.