MULTIPLE HEPATITIS-VIRUS INFECTIONS IN CHRONIC HBSAG-CARRIERS IN NAPLES

In order to determine the prevalence of multiple infections with hepat itis viruses in chronic HBsAg carriers in Naples, to assess the intera ction between HBV, HDV and HCV infections and to evaluate the influenc e of multiple virus hepatitis infections on the clinical presentation, we studied 198 HBsAg chronic carriers observed consecutively from 197 1 to 1988 at our Liver Unit. Of the 198 HBsAg chronic carriers, 171 ha d undergone percutaneous liver biopsy. The presence of HBcAg or HDAg i n the liver biopsy was considered a marker of HBV or HDV replication, respectively; the presence of anti-HCV was considered a marker of HCV infection. Anti-HCV was observed in 13.6% of the 22 subjects with norm al liver, in 27.7% of the 47 patients with minimal chronic hepatitis, in 40% of the 50 with mild chronic hepatitis, in 70.6% of the 17 with moderate hepatitis, in 66.7% of the 3 with severe chronic hepatitis an d in 65.6% of the 32 with active cirrhosis. Anti-HCV positive cases we re antiHD positive more frequently than the anti-HCV negative (59.2% v s. 43%, p = 0.05). HDV infection exerted a clear inhibition on the HBV genome. Among the 171 HBsAg chronic carriers, the finding of an activ e chronic hepatitis (moderate chronic hepatitis + severe chronic hepat itis + active cirrhosis) is less frequent in subjects with HBV replica tion alone than in those with HDV replication or HCV infection. Patien ts with both HBV replication and HCV infection and those with both HDV replication and HCV infection showed a very high prevelance of active chronic hepatitis.