HEPATITIS-B VIRUS (HBV) HEPATITIS-D VIRUS (HDV) COINFECTION IN OUTBREAKS OF ACUTE HEPATITIS IN THE PERUVIAN AMAZON BASIN - THE ROLES OF HDVGENOTYPE-III AND HBV GENOTYPE-F

Recurring outbreaks of acute hepatitis have been a significant cause o f morbidity and mortality among Peruvian military personnel stationed in the Amazon Basin region of Peru. The role of hepatitis B virus (HBV ) and hepatitis D virus (HDV) infection was investigated as the possib le cause of acute hepatitis among 88 military patients stationed at fo ur different jungle outposts during 1992-1993. Analysis of serum marke rs indicated that 95% (84/88) had evidence of acute HBV infection; 64% (54/84) mere also infected with HDV, Genetic analysis of PCR-amplifie d HDV and HBV fragments showed exclusively HDV genotype III and HBV ge notype F. Furthermore, HDV RNA sequences were similar among patients f rom the same outpost but different from those at other jungle location s. The data suggested focal sources of HDV infection in the jungle env ironment of the outposts and, further, confirmed the unique associatio n of HDV genotype III with severe cases of human disease in northern S outh America.