Changing pattern of chronic hepatitis D in southern Europe

Background & Aims: The aim of this study was to assess changes in the clini cal pattern of hepatitis D virus (HDV) infection in Italy, brought about by improved control of hepatitis B and D viruses, and to establish the natura l history of chronic hepatitis D. Methods: Histological diagnosis and clini cal features of 122 patients with HDV recruited from 1987 to 1996 in three Italian tertiary referral centers (Torino, northern Italy; San Giovanni Rot ondo and Castellana Grotte, southern Italy) were compared with those of 162 patients collected in the same centers in the previous decade. Patients fr om both groups with at least 6 months of follow-up were included in a new s ubgroup to assess the natural history of the disease. Results: Among 162 pa tients referred from 1977 to 1986, 9 (6%) had mild hepatitis at histology v s. 9 (8%) of 122 patients referred in the second decade; 105 (65%) vs. 21 ( 17%) had severe hepatitis; 46 (28%) vs. 38 (31%) had histological asymptoma tic cirrhosis; and 2 (1%) vs. 54 (44%) had clinically overt cirrhosis. For 159 patients (121 men and 38 women; mean age, 34 +/- 11), a follow-up of mo re than 6 months was documented, and they were included in the natural hist ory subgroup. After 78 +/- 59 months of follow-up, 112 (70%) survived free of liver transplantation: 9 underwent transplantation, 32 died of liver fai lure, and 6 of acquired immunodeficiency syndrome. Estimated 5- and 10-year probability of survival free of orthotopic liver transplantation was 100% and 100% for patients with mild hepatitis, 90% and 90% for severe hepatitis , 81% and 58% for histological asymptomatic cirrhosis, and 49% and 40% for clinical cirrhosis (P < 0.01), respectively. Conclusions: Occurrence of fre sh and severe forms of hepatitis D has diminished greatly in Italy. Contemp orary patients represent cohorts infected years ago who survived the immedi ate medical impact of hepatitis D. The disease has been asymptomatic and no nprogressive in a minority; in the majority, it rapidly advanced to cirrhos is but. thereafter subsided with stable clinical conditions for more than a decade.