Significance of delta agent infection in chronic hepatitis B virus infection: a study in British carriers.

Abstract

SUMMARY Delta antigen (6) is a transmissible agent requiring hepatitis B virus (HBV) for its replication. Antibody to 6 (anti-b) was present in nine of 71 (13%) British HBV carriers: six were intravenous drug abusers and two were haemophiliacs. Anti-6 was negative in 30 HBsAg positive homosexuals. Cirrhosis was common in patients with anti-6 and those with anti-6 positive cirrhosis were significantly younger than those with anti-6 negative cirrhosis. In British HBV carriers 6 infection is associated with intravenous drug abuse and haemophilia and perhaps a more rapid progression of chronic liver disease.Delta antigen (6) was discovered by direct immunofluorescence in hepatocyte nuclei of Italian patients with chronic hepatitis B virus (HBV) infection; it is distinct from other HBV antigens. ' Hepatitis B virus carriers with 6 in the liver have a serum antibody (anti-b) in high titre detectable by radioimmunoassay and 6 itself has been extracted from liver and serum.2-4 Delta antigen from liver is a protein of 68 000 daltons.2 In serum it is associated with a low molecular weight RNA encapsulated by hepatitis B surface antigen (HBsAg) in a 35-37 nm subpopulation of particles.3 4Studies in chimpanzees suggest that 6 is a marker of a transmissible pathogenic agent, either a variant of HBV or another virus which requires HBV for its replication.5 6 Anti-b is prevalent in Italian HBV carriers and more common in patients with chronic liver disease.7 The prevalence of anti-6 in British HBV carriers is unknown. The aim of this study was to determine whether 6 infection is common in British HBV carriers and its significance in terms of predicting the severity of chronic liver disease. Methods PATIENTSSeventy one HBsAg carriers born and resident in Great Britain were studied. Sixty four men and seven women; mean age 36 years (range 11-67 years). Forty five were HBeAg and 26 anti-HBe

Randomised controlled trial of adenine arabinoside 5'-monophosphate (ARA-AMP) in chronic hepatitis B virus infection.

“…In the two intravenous drug abusers who had superinfection with the delta agent, transaminases remained raised and inflammatory activity persisted. This observation is consistent with evidence that in chronic HBV carriers with concomitant delta infection there is a more rapid progression of chronic liver disease.26 27 Thus the continuing inflammation in the two delta infected patients was probably attributable to this superinfection and not to continuing HBV infection. Liver histology showed no significant change in the untreated and treated non-responder groups.…”

The Delta Agent

“…Carriers with chronic 6 liver disease usually have active hepatitis or cirrhosis; a minority have chronic persistent or lobular hepatitis. This association with various forms of liver disease has been emphasized by all reports (26,27,(30)(31)(32)(33)(34). The chronic hepatitis is often rapidly progressive.…”

“…This association with various forms of liver disease has been emphasized by all reports (26,27,(30)(31)(32)(33)(34). The chronic hepatitis is often rapidly progressive.…”

Hepatitis D virus antibody in HBsAg‐positive and HBsAg‐negative substance abusers with chronic liver disease

“…It was first described [Rizzetto et al, 19771 in the serum of Italian carriers of the hepatitis B surface antigen (HBsAg) and is endemic in the Mediterranean area [Ruzetto et al, 1980al. Parenteral drug abusers, who are frequently infected with HBV [Kreek et al, 1972;Novick et al, 19811 are at high risk for HDV infection and are probably responsible for the spread of this virus to nonendemic areas such as Northern Europe and the United States Weller et al, 1983;Lok et al, 19831. Patients with persistent infection with HDV and HBV have rapidly progressive liver disease of greater severity than that seen with chronic HBV infection alone Farci et al, 19851. During HDV infection, hepatitis D antigen (HDAg) is seen initially but is shortly succeeded by hepatitis D antibody (anti-HDV) [Rizzetto, 19831.…”