We report two cases of fulminant hepatic failure in HIV-1-infected patients treated with didanosine (ddI). Clinical manifestations including vomiting, diarrhoea and dyspnoea were identical in both cases. Biological data mainly revealed hepatic failure and lactic acidosis. Histological examination of liver biopsies showed diffuse microvesicular steatosis. The outcome was fatal in both patients. The only comparable case previously reported (Lai et al., 1991) showed close similarities in the clinical, biological and histological manifestations with microvesicular steatosis. This prompted us to suspect that ddI might be responsible for fulminant hepatitis in all three AIDS patients. This toxic effect may be added to the list of potential adverse events occurring during ddI therapy.

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The detection of HAA was proved positive in 6 cases out of 7 histologically confirmed PAN.The presence of HAA does not necessarily depend on the evidence of hepatic manifestations. In those 7 cases were indeed observed 2 initial icteric hepatitis biologically and histologically proved, 4 transitory hepatomegalies, and in the last case (which was not the HAA negative one), no hepatic manifestation could be detected. It was possible to prove for at least 4 patients that they did not receive transfusions previously. The detection of HAA was performed by immunodiffusion test only, and our results were controlled in Paris and Lyon. In 2 cases the antigen and the antibody were observed simultaneously.Apparently the antigen appears very precociously and persists for a fairly long time because we can follow its persistency after 30 months in 1 case. To explain these facts, 3 hypothesis can be proposed:1. HAA is not specific of viral hepatitis.2. PAN realizes a highly propicious ground, regarding eventually immunodepressive or corticosteroid therapy, to the development of a subacute anicteric hepatitis with persistant antigenemia as in Down's syndrome.3. Viral hepatitis with HAA seem to represent a disease with antigen-antibody circulating complexes, which could provoke the injuries of PAN.

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Antibodies (anti-HD) to hepatitis delta virus (HDV) were tested by radioimmunoassay in 207 human serum samples from the eastern Amazon (states of Pará and Amapá) and São Paulo, Brazil. 42 Amazon HBsAg asymptomatic carriers were negative for anti-HD. 84 São Paulo HBsAg asymptomatic carriers were also negative. Among the 81 HBsAg patients from São Paulo with different liver diseases, only one had anti-HD. Liver biopsy of this chronic active hepatitis case was positive for HBsAg, HBcAg and HDAg in liver, by an immunoperoxidase technique. The low prevalence of HDV infections in São Paulo and eastern Amazon was unexpected and contrasts with the recent reports of high prevalence in the western Amazon region. Such regional differences emphasize the need for extensive and precise worldwide epidemiological studies of HDV.