CLINICAL AND VIROLOGICAL COURSE OF CHRONIC HEPATITIS-B VIRUS-INFECTION WITH HEPATITIS-C AND HEPATITIS-D VIRUS MARKERS

Objective: Hepatitis B, C, and delta virus (HBV, HCV, HDV) share simil ar transmission routes; thus, dual or triple infections may occur and even persist in the same patient. However, little is known about the p resentations and course of chronic HBV infection with HCV and HDV mark ers, which this study examined. Methods: Antibodies against HCV (anti- HCV) and HDV (anti-HDV) were assayed as appropriate in patients with H BV infection. The clinical, pathological, and virological presentation s as well as the course of the disease in patients with HBV/HDV/HCV tr iple infection markers were then reviewed. Results: A total of 60 pati ents, 51 men and nine women, age 19-67 yr (mean 45.9 +/- 1.6 yr) were identified. Of these 60 patients, five (8.3%) were HBeAg positive and 10 (16.7%) cirrhotic at entry, 30 (50%) presented with acute superinfe ction (HCV or HDV, or both) and the remaining 30 presented with chroni c liver disease. On presentation, 16 (53.3%) of the 30 patients with a cute superinfection showed hepatic decompensation and eight (26.7%) di ed. In contrast, only one of the patients with ''chronic liver disease '' presented with hepatic decompensation. Of the 42 patients followed up for 1-15 (mean, 4.7 +/- 0.6) yr, 45.2% showed remission and 19% sho wed HBsAg seroclearance, whereas 12.5% of the 32 noncirrhotics develop ed cirrhosis and three of the nine cirrhotics became decompensated. At the end of follow-up, 29 patients (69.9%) were still seropositive for HCV-RNA but only nine (22.5%) were seropositive for HDV-RNA and five (12.5%) were seropositive for HBV-DNA. Conclusions: These results sugg est that infection with HBV, HCV, and HDV triple markers is a severe d isease in acute superinfection stage but that the course is relatively benign, slowly progressive, and usually dominated by HCV. (C) 1998 by Am. Coll. of Gastroenterology.