Correlation between hepatitis B viremia and the clinical and histological activity of chronic delta hepatitis

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.

Viral replication in patients with concomitant hepatitis B and C virus infections

“…The interaction between HCV and HBV may be similar to the interaction of HBV and HDV in that the dual infection may cause more severe disease (21,41). Some studies in patients with HBV/HCV infections showed an inverse relationship between HBV and HCV replication.…”

“…All assays were performed using sera from adults vaccinated against HBV as negative control. Amplification using the Taq polymerase was performed as described previously (20,21) in a 100 Ixl reaction volume containing 10 txl DNA sample, 10 ~1 buffer (10 mM Tris HC1 of pH 8.3, 50 mM KC1, 1.5 mM MgC12, 0.01% gelatin), 200 jxM each dNTE 1 p~M each primer and 2,5 units ofTaq polymerase (Perkin EImet Cetus, USA). Thirty cycles of 1.3 min denaturation at 94~ 1.3 min annealing at 42~ and 3 rain extension at 72~ followed by final extension at 72~ for 10 min were performed in a programmable DNA thermal cycler (Perkin Elmer Cetus, USA).…”

Quantitation of the Level of Hepatitis Delta Virus RNA in Serum, by Real‐Time Polymerase Chain Reaction—and Its Possible Correlation with the Clinical Stage of Liver Disease

“…It has been unclear whether HBV or HDV is primarily responsible for liver damage in patients with chronic HDV. Some studies have suggested that liver-disease activity is related to HDV [20][21][22], whereas others have indicated that it is related to HBV [23][24][25]. In our previous study, we did not find in subjects positive for anti-HD any correlation between the level of HBV DNA (assayed by use of real-time RT-PCR) and the level of ALT; this suggests that HBV plays a minor role in the liver damage seen in patients positive for anti-HD [5].…”

Hepatitis delta: virological and clinical aspects

“…These data suggest that there is a suppression of HBV by HDV, but with important replication fluctuation of the two viruses [ 104 ]. The persistence of HBV replication, even at minimum levels, is associated with worse hepatocellular damage [ 105 ]. A third form has been described in patients after liver transplantation: latent infection [ 101 ].…”