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[Characteristics of chronic delta hepatitis in patients wih HIV infection]
M De Pouplana1, V Soriano, J García-Samaniego
1Servicio de Enfermedades Infecciosas. Centro de Investigaciones Clínicas. Instituto de Salud Carlos III, Madrid.
Background:
Hepatitis Delta virus (HDV) induces severe liver disease in HBsAg carriers. In regions such as Spain, drug addicts make-up a large part of the HIV-positive population and they are at risk of HDV infection. Natural history of chronic hepatitis D is not well known in HIV-infected patients.
Methods:
We reviewed the clinical charts of 37 patients attending our institution from 1989 to 1993, fulfilling the criteria for chronic hepatitis D. We compared all clinical, epidemiological, serological and histological findings between both HIV-positive and HIV-negative patients.
Results:
All the following parameters showed significant statistical differences between the both groups: mean ALT levels (175 vs 79 respectively, p < 0.05), previous episodes of hepatic decompensation (37% vs 10%, p < 0.01), the circulating Delta antigen (26% vs 10%, p < 0.05), the presence of HBeAg in serum (41% vs 0%, p < 0.01) and the HCV coinfection (85% vs 20%, p < 0.01). Histological findings were not significantly different comparing both groups, as chronic active hepatitis with cirrhosis was the most common diagnosis.
Conclusion:
Chronic hepatitis D may present a more severe course in HIV-infected patients. The higher replication of HDV and the presence of HCV coinfection could explain this worst outcome.