Delta antigen positive chronic liver disease in Greece: clinical aspects and natural course

Chronic delta infection occurs in Greece in about 10 to 15% of HBsAg+ subjects, being largely unrelated to parenteral transmission and/or to drug addiction. The observed cases exhibited histological changes ranging from chronic persistent hepatitis to chronic active hepatitis, cirrhosis, and even hepatocellular carcinoma on cirrhosis. The male/female ratio of patients with delta Ag + CLD was 3.8:1 and their mean age 40 years. They were younger compared to delta Ag-/HBsAg+ CLD and they presented with a wide spectrum of symptoms and signs. About 25% of the patients were oligosymptomatic or asymptomatic and about 40% manifested their disease as an episode of acute hepatitis with protracted or relapsing course followed by chronicity. Biochemical changes appeared to be more severe than in delta Ag-/HBsAg + CLD. The natural history was frequently characterised by a progressive course, terminating, in about 15 years, to death from cirrhosis and liver failure, although remissions occasionally occurred. HCC also developed but probably less frequently than in HBsAg positive, delta Ag negative CLD. Whether the natural course of delta Ag+ CLD can be modified by any form of treatment remains to be proved.