CHRONIC DELTA-HEPATITIS - IS THE PROGNOSIS WORSE WHEN ASSOCIATED WITHHEPATITIS-C VIRUS AND HUMAN-IMMUNODEFICIENCY-VIRUS INFECTIONS

Eighty-six patients were followed for 6.5 years to study the epidemiol ogical, virological, and histological course of chronic delta hepatiti s and the relationship of this disease with HIV and HCV infection. Pat ients were classified into four groups according to simultaneous HCV a nd/or HIV infection: group 1, HDV infection (20 cases); group 2, HDV a nd HCV infection (11 cases); group 3, HDV and HIV infection (12 cases) , and group 4, HDV, HCV, and HIV infection (43 cases). All but 14 pati ents were asymptomatic at presentation. Liver histology showed chronic active hepatitis in 53 cases and cirrhosis in 19 cases. During follow up, 52 patients remained asymptomatic, 34 developed hepatic dysfunctio n, 28 died, and 1 received a liver transplant. Among the 28 patients w ho died, 4 had HDV infection; 3 HDV and HCV infection; 3 HDV and HIV i nfection; and 18 HDV, HCV, and HIV infection. Death was due to liver f ailure in 16 (57%), AIDS in 10 (36%), and was unrelated to liver disea se in 2 (8%) cases. There results demonstrate that chronic delta hepat itis is a severe disease, especially among drug users with HIV and HCV infection. The high morbidity and mortality of chronic delta hepatiti s justifies the use of antiviral therapy to modify the natural course of the disease. (C) 1996 Wiley-Liss, Inc.