Chronic hepatitis D: A vanishing disease? An Italian multicenter study

Abstract

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...

Chronic hepatitis B

“…The availability of HBV vaccines and public health education on prevention of transmission of HBV infection has led to a significant decline in the prevalence of HDV infection in the past decade. 88,89 HDV infection can occur in two forms. The first form is caused by the coinfection of HBV and HDV; this usually results in a more severe acute hepatitis with a higher mortality rate than is seen with acute hepatitis B alone, 87,90 but rarely results in chronic infection.…”

Hepatitis delta-associated mortality in HIV/HBV-coinfected patients

“…The prevalence of anti-HDV antibodies seems even higher in HIV/HBV-coinfected patients from SSA, reaching 25% in GuineaBissau 5 . Although the prevalence of HDV infection seems to decrease in some regions, most probably due to HBV preventive measures 6 , this is not the case in Northern Europe, where most cases are now diagnosed in young migrants from endemic regions 2 .…”

Delta Hepatitis

“…Since 1990's, HDV infection has decreased significantly in Europe [35,36]. In sequential surveys in Italy, rate of anti-HDV seropositivity was found equal to 24.6% in 1983 [37], 14% in 1992 [38], and 8.3 in 1997 [39]. A similar decreasing rate in HDV seropositivity was also seen in Spain [40].…”