ROLE OF HEPATITIS-C AND HEPATITIS-DELTA VIRUSES IN THE TERMINATION OFCHRONIC HEPATITIS-B SURFACE-ANTIGEN CARRIER STATE - A MULTIVARIATE-ANALYSIS IN A LONGITUDINAL FOLLOW-UP-STUDY

Influences of hepatitis delta (HDV) or C virus (HCV) superinfection on the spontaneous clearance of hepatitis B virus (HBV) surface antigen (HBsAg) were investigated in 992 patients. Patients were infected with HBV alone (group 1), HBV and HDV (group 2), HBV and HCV (group 3), or all three viruses (group 4). They were followed for 6.2 +/- 3.7 years . Thirty-six patients (3.6%) had spontaneous serum HBsAg clearance. Th ere was an increasing linear trend in the annual incidence from 0.43% (group 1) to 0.64% (group 2), 2.08% (group 3), and 2.33% (group 4; P < .0001). Relative risk (RR) of group 3 to 1 was 4.8 (P < .001) and of group 4 to 1 was 5.1 (P < .02). RR was significantly higher in group 3 than 2 (P < .02). By Cox multivariate regression analysis, only HCV s uperinfection and age at entry were significant influencing factors. M oreover, there was a significant interaction between HCV and age. Pati ents > 35 years old with HCV had a higher HBsAg clearance rate. Result s suggest that HCV is the most important hepatotropic virus that enhan ces HBsAg clearance in chronic hepatitis B.