Hepatitis delta virus (HDV) infection was endemic in the 1970s throughout Southern Europe, where it was responsible for a substantial proportion of cases of hepatitis B surface antigen (HBsAg)-positive liver disorders. 1-4 However, by the 1990s the circulation of HDV in Southern Europe had substantially declined, as indicated in Italy by the decrease in the incidence of acute hepatitis delta from 3.1 of 1,000,000 inhabitants in 1987 to 1.2 of 1,000,000 in 1992 5 and by the decrease in the prevalence of antibody to HDV (anti-HDV) among HBsAg carriers with liver disease from 25% in 1983 2 to 14% in 1992 6 in Italy and from 15.1% to 7.1% in Spain. 7 We have assessed in the present multicenter study the prevalence of HDV infection in 834 Italian HBsAg carriers collected in 1997. The prevalence of infection, modes of transmission, and its current clinical impact were compared with those determined in the previous nation-wide surveys conducted in 1987 and 1992. PATIENTS AND METHODSThe study was performed in 14 referral liver units throughout Italy. In each center all consecutive HBsAg chronic carriers observed in 1997 with HBsAg positivity documented for at least 12 months were evaluated. Polytransfused patients, those with an antibody to human immunodeficiency virus (anti-HIV)-positive tests, and those with serologic and/or ultrasound evidence of hepatocellular carcinoma were not included. In all, 834 HBsAg carriers were enrolled in the study. Anti-HDV antibodies in serum were sought in all subjects using commercial enzyme-linked immunosorbent assay tests. For each patient a standardized questionnaire 4,6 was completed, containing the demographic data, personal history with special reference to the exposure to risk factors, and a section with clinical and histologic data. The items on risk factors explored environmental and lifestyle risks, intravenous drug use, intrafamily risks (including spread in spouses), and the risk of sexual transmission (explored by the variable "sexual intercourse with a drug addict").To allow a comparison with the 2 previous surveys performed in 1987 and in 1992 4,6 we adopted the same questionnaire. All the centers that participated in the present study also participated in the previous 2 and the distribution of the centers was comparable. Liver biopsies were performed in 46% of the cases, in accordance with the independent diagnostic criteria of each referral center. All participating centers used the Knodell score for necroinflammation 8 and the Sheuer 9 score for fibrosis. To allow a comparison with the 2 previous national surveys the results of Knodell scores were categorized as follows: Յ8 ϭ chronic persistent hepatitis; greater than 8 ϭ chronic active hepatitis. The diagnosis of cirrhosis was made in the presence of a fibrosis score equal to 4. A clinical diagnosis of cirrhosis was made on the basis of unequivocal clinical, laboratory, and imaging results.Statistical Analysis. The differences in the prevalences were evaluated using the 2 test. A P value Ͻ .05 was considered signific...

Haematologic patients should be screened for hepatitis B surface antigen (HBsAg) plus anti-hepatitis B core protein (HBc), and HBV DNA before chemotherapy. HBV DNA levels should be monitored monthly in all HBV-positive patients who do not receive prophylaxis. HBsAg-positive haematologic patients and those undergoing HSCT should receive third-generation antiviral therapy as prophylaxis. Anti-HBc-positive lymphoma patients and those receiving HSCT should receive antiviral prophylaxis. All HBV-negative haematologic patients should be vaccinated for HBV. The acquisition of data from well-designed studies is desirable in the near future.

the update of the present study confirms that tamoxifen is not effective in prolonging survivals, both in advanced patients and in those potentially curable and that the CLIP score is able to predict prognosis.

SUMMARY BackgroundIn patients with chronic hepatitis B, tenofovir disoproxil fumarate (TDF) plus pegylated interferon (PEG-IFN) for 48-weeks results in higher rates of hepatitis B surface antigen (HBsAg) loss than either monotherapy.

A multicentre cross-sectional survey was performed to provide an accurate picture of patients with chronic hepatitis B (CHB) cared for by Italian Infectious Diseases Centers (IDCs). This analysis describes factors associated with access to the treatment of CHB in a country where barriers to treatment are not expected to exist because of comprehensive coverage under the National Health System (NHS). The study was performed in 74 IDCs. The analysis focused on 3305 patients with CHB of 3760 HBsAg-positive patients enrolled from March to September, 2008. To account for missing values, a Multiple Imputation method was used. Treatment was reported in 2091 (63.3%) patients. In the multivariate analysis, an increased chance of getting treatment was independently associated with 10 years increase of age at diagnosis (adjusted odds ratio [aOR] 1.2, 95% confidence interval [CI] 1.1-1.3, P < 0.001), HBeAg positivity (aOR 1.8, 95% CI 1.1-2.8, P < 0.001), cirrhosis (aOR 3.6, 95% CI 2-6.3, P = 0.012), HDV (aOR 1.6, 95% CI 1.02-2.5, P = 0.042) and HIV positivity (aOR 6.5, 95% CI 4-10.8, P < 0.001). Conversely, a decreased chance was associated with female gender (aOR 0.6, 95% CI 0.5-0.7, P < 0.001), immigration (aOR 0.6, 95% CI 0.5-0.9, P = 0.009), alcohol consumption (aOR 0.7, 95% CI 0.5-0.98, P = 0.04) and HCV positivity (aOR 0.5, 95% CI 0.3-0.8, P = 0.005). Our study shows that Italian IDCs treat a high percentage of patients with CHB. Nevertheless, disparities exist which are not related to the severity of disease limiting access to antiviral therapy of CHB, even in a country with a universal healthcare system.