NATURAL-HISTORY OF HEPATITIS-D VIRAL SUPERINFECTION - SIGNIFICANCE OFVIREMIA DETECTED BY POLYMERASE CHAIN-REACTION

Background/Aims: Polymerase chain reaction (PCR) is very sensitive. Th e aim of the study was to reevaluate viral replication in hepatitis D virus (HDV) superinfection by PCR. Methods: HDV and hepatitis B virus (HBV) were detected by PCR in 185 patients. Results: The acute hepatit is group had the highest detection rate of HDV RNA compared with chron ic hepatitis, cirrhosis, hepatocellular carcinoma, and remission group s (63 of 64 vs. 35 of 47, 17 of 23, 19 of 30, and 7 of 21) and the hig hest alanine aminotransferase (ALT) levels (mean, 1741 U/L vs. 266 to 27 U/L; P < 0.05). The detection rate of HBV DNA was the lowest in the acute group (41%) compared with 66%, 70%, 80%, and 57% in the remaini ng groups (P < 0.02). At the chronic stage, 13%-25% of cases had HDV R NA, and 30%-48% of cases had HBV DNA detected by PCR but not by tradit ional method. HDV RNA was associated with ALT levels in horizontal and longitudinal analyses. Conclusions: HDV superinfection may be divided into the following three phases: acute phase, active HDV replication and suppression of HBV with high ALT levels; chronic phase, decreasing HDV and reactivating HBV with moderate ALT levels; and late phase, de velopment of cirrhosis and hepatocellular carcinoma caused by replicat ion of either virus or remission resulting from marked reduction of bo th viruses.