Correlation of hepatitis B virus, hepatitis D virus and human immunodeficiency virus type I infection markers in hepatitis B surface antigen positive haemophiliacs and patients without haemophilia with clinical and histopathological outcome of hepatitis

Abstract

The hepatitis D virus (HDV) infection plays a major role in severe liver damage caused by hepatitis. To establish the prevalence of HDV infection in haemophilic patients and patients without haemophilia, 87 patients with chronic hepatitis B virus (HBV) infection were examined for serological evidence of delta hepatitis. In addition HBV, HDV and human immunodeficiency virus type 1 (HIV) infection markers were compared to clinical and histopathological outcome of hepatitis. Out of 46 haemophiliacs 30 (65%) were anti-HD-seropositive; 10 out of 30 anti-HD-positive patients (33%) had pathological liver function tests compared to 2 out of 16 anti-HD-negative haemophiliacs (13%). The rate of HIV infection did not differ between the HDV infected and the non-HDV infected individuals with haemophilia (17/27 anti-HD-positive patients versus 12/16 anti-HD-negative patients). Two haemophilic anti-HD-positive patients underwent liver biopsy, in both cases hepatitis D antigen (HDAg) was detected in the biopsies. Only 2 out of 41 patients without haemophilia were anti-HD-positive. Both had pathological liver function tests; chronic active hepatitis and cirrhosis, respectively, were diagnosed and HDAg was found in the liver biopsies. Out of 39 anti-HD-seronegative patients without haemophilia, 26 (67%) were hepatitis B e antigen positive; in the sera of 20 patients (51%) HBV-DNA was demonstrated, but only 6 patients (15%) had pathological liver function tests. In conclusion a high seroprevalence of HDV infection was found in haemophilic patients treated with non-pasteurized commercial clotting factor concentrates. An endemic spreading of HDV infection in patients without haemophilia with chronic HBV infection could not be detected.(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatitis C contributes to liver disease in children and adolescents with hemophilia

“…Whether this refleets the presence of several contaminating infectious agents in the clotting factor concentrates used or is due to a higher susceptibility to infectious agents in HIV-1 infected patients remains unclear. The influence of HIV-1 infection on the course of liver disease continues to be a controversial issue (3,18,20,27). In this study 47% of the anti-HIV-I positive group compared to 20.7% of the anti-HIV-1 negative group presented with liver enzyme abnormalities.…”

“…The presence of two hepatotoxic infectious agents (i.e. HCV and HBV) may worsen the prognosis, as already seen in patients with chronic hepatitis Band hepatitis 0 superinfection (27).…”

“…Hemophilic children exposed to commercial non-virus-inactivated c10tting factor concentrates are at risk for transmission of infectious agents such as human immunodeficiency virus type 1 (HIV-1), hepatitis B virus (HBV) and hepatitis D virus (HDV) (12,14,26,27). In addition non-A, non-B hepatitis (NANB) plays an important role as it is known to lead to cirrhosis in Klin…”