CORRELATION BETWEEN HEPATITIS-B VIREMIA AND THE CLINICAL AND HISTOLOGICAL ACTIVITY OF CHRONIC DELTA-HEPATITIS

To analyze the serological, clinical and histological significance of hepatitis B virus (HBV) replication among a group of patients with chr onic delta hepatitis (CDH), wt have studied the clinical and the histo logical activity in 49 patients with CDH. The HBV-DNA was analyzed by dot-blot and polymerase chain reaction (PCR). Concomitant infection wi th hepatitis C virus (HCV) was analyzed by reverse transcriptase (RT)- PCR, HDV replication by dot-blot, and human immunodeficiency virus (HI V) infection by enzyme-linked immunosorbent assay. The subjects were d ivided into three groups according to HBV-DNA status: group I: 14 pati ents HBV-DNA dot-blot positive; group II: 29 patients HBV-DNA positive only by PCR, and group III: 6 patients HBV-DNA negative by dot-blot a nd PCR. We have found HBV-DNA by dot-blot in 28.5% of patients, and by PCR in 87.7%. Also 22 patients were anti-HCV positive (86.3% had HCV- RNA by RT-PCR). The first group (HBV-DNA dot-blot positive) had signif icantly higher serum alanine aminotransferase (ALT) and aspartate amin otransferase (AST) than those in the second and third groups. Likewise , serum ALT and AST were significantly higher in the second group (HBV -DNA positive by PCR) than in those of the third group. Histological i nflammatory activity was significantly higher in the group of patients with HBV-DNA detectable by dot-blot. The prevalence of serum HDV-RNA and IgM anti-HDV were similar in the three groups. These results were similar in the anti-HCV-positive and -negative patients. In conclusion , these data suggest that: (1) persistence of HBV replication is a maj or determinant of severe liver damage in chronic delta hepatitis, and (2) HCV and HIV infections do not influence the natural history of CDH .