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Correlation between hepatitis B viremia and the clinical and histological activity of chronic delta hepatitis
J L Lozano1, J Crespo, F de la Cruz
1Gastroenterology and Hepatology Unit, University Hospital Marqués de Valdecilla, Faculty of Medicine, Santander, Spain.
Insights
Persistent hepatitis B virus (HBV) replication significantly worsens liver damage in chronic delta hepatitis (CDH). Hepatitis C virus (HCV) and HIV infections did not impact CDH progression.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Chronic delta hepatitis (CDH) is a serious liver condition.
- Understanding hepatitis B virus (HBV) replication is crucial for managing CDH.
- Co-infections with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are common.
Purpose of the Study:
- To investigate the significance of HBV replication in CDH.
- To analyze serological, clinical, and histological markers of liver damage.
- To assess the impact of HCV and HIV co-infections on CDH.
Main Methods:
- Studied 49 patients with CDH.
- Analyzed HBV-DNA using dot-blot and PCR.
- Detected HCV-RNA by RT-PCR and HIV by ELISA.
- Assessed liver histology and serum enzyme levels (ALT, AST).
Main Results:
- HBV-DNA detected by PCR in 87.7% of patients.
- Higher ALT and AST levels correlated with detectable HBV-DNA.
- Significant inflammatory activity in patients with HBV-DNA detectable by dot-blot.
- HCV co-infection present in 86.3% of anti-HCV positive patients.
Conclusions:
- Persistent HBV replication is a key factor in severe liver damage in CDH.
- HCV and HIV co-infections do not alter the natural course of CDH.
- HBV replication levels correlate with liver disease severity.
Abstract:
To analyze the serological, clinical and histological significance of hepatitis B virus (HBV) replication among a group of patients with chronic delta hepatitis (CDH), we have studied the clinical and the histological activity in 49 patients with CDH. The HBV-DNA was analyzed by dot-blot and polymerase chain reaction (PCR). Concomitant infection with hepatitis C virus (HCV) was analyzed by reverse transcriptase (RT)-PCR, HDV replication by dot-blot, and human immunodeficiency virus (HIV) infection by enzyme-linked immunosorbent assay. The subjects were divided into three groups according to HBV-DNA status: group I: 14 patients HBV-DNA dot-blot positive; group II: 29 patients HBV-DNA positive only by PCR, and group III: 6 patients HBV-DNA negative by dot-blot and PCR. We have found HBV-DNA by dot-blot in 28.5% of patients, and by PCR in 87.7%. Also 22 patients were anti-HCV positive (86.3% had HCV-RNA by RT-PCR). The first group (HBV-DNA dot-blot positive) had significantly higher serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) than those in the second and third groups. Likewise, serum ALT and AST were significantly higher in the second group (HBV-DNA positive by PCR) than in those of the third group. Histological inflammatory activity was significantly higher in the group of patients with HBV-DNA detectable by dot-blot. The prevalence of serum HDV-RNA and IgM anti-HDV were similar in the three groups. These results were similar in the anti-HCV-positive and -negative patients. In conclusion, these data suggest that: (1) persistence of HBV replication is a major determinant of severe liver damage in chronic delta hepatitis, and (2) HCV and HIV infections do not influence the natural history of CDH.