Prevalence of anti-delta antibodies in central India.

A total of 238 sera samples from cases of hepatitis, renal failure, thalassaemia, healthy health care workers (HCWs) & asymptomatic HBsAG carriers coming from central India from July 1992 to June 1998, were screened for anti-delta antibodies. Among 238 subjects, 206 were reactive for hepatitis B surface antigen (HBsAg) while 32 were HBsAg non-reactive. The prevalence of anti-delta antibodies was low (1.9%) among 54 patients of acute viral hepatitis (AVH) while it was higher (5.7%) among 52 patients of chronic liver disease (CLD). The anti-delta antibodies positivity among 34 patients with hepatic failure was around 15% and all of them were FHF patients. Among multitransfused subjects such as chronic renal failure (CRF) the prevalence of anti-delta antibodies was low (2.3%). None of the apparently healthy HBsAg reactive HCWs and asymptomatic HBV carriers were reactive for anti-delta antibodies. Similarly anti-delta antibodies could not be detected in HBsAg negative viral hepatitis patients. There is a wide variation in the prevalence of anti-delta antibodies in different parts of India. However, overall prevalence of anti-delta antibodies appears to be lower in the Indian population in comparision to western countries.

Aetiology and prognostic factors in hepatic failure in central India.

The present study was undertaken to establish the aetiology and prognostic factors of liver failure in central India. Of the 122 cases of hepatic failure 95 (78%), 19 (15.5%) and 8 (6.5%) were labelled as fulminant hepatic failure (FHF), chronic hepatic failure (CHF) and subacute hepatic failure (SAHF) respectively. Hepatitis E virus (HEV) and hepatitis B virus (HBV) were aetiological agents amongst 41% (n = 39) and 37% (n = 35) patients with FHF respectively. Mixed infection among such cases even though observed was infrequent and 15% (n = 14) of FHF did not have any serological markers. They were presumed to be due to non A-E viral infection. Thirty-one (33%) of the FHF patients were pregnant and 29 (94%) of them were due to HEV. Amongst patients with SAHF and CHF, HBV and HCV were important aetiological agents. The static prognostic risk factors noted in the present study are age above 40 years, presence of identifiable viral aetiology (A to E), alcoholic status in males and pregnancy particularly in the third trimester or postpartum state. Among the dynamic factors, bilirubin level above 20 mg/dl and prothrombin time over 20 seconds appeared to be the risk factors.

Prevalence of anti-HCV antibodies in central India.

The study group screened for anti-HCV comprised 789 subjects of hepatitis, renal failure, thalassaemia and healthy voluntary blood donors coming from Central India during July 1992 to November 1995. The prevalence of HCV was low (4.85%) among 103 patients of acute viral hepatitis (AVH) while it was higher (25.64%) among 117 patients of chronic liver disease (CLD) with the highest rate of 31.57 percent in 57 patients of cirrhosis. The anti-HCV positivity among 101 patients with hepatic failure was around 10 percent. High risk groups such as chronic renal failure (CRF) patients mainly on haemodialysis and thalassaemics receiving multiple blood transfusions showed the prevalence of anti-HCV in 41.9 and 25.45 percent respectively. Only 1.78 percent of the 280 voluntary blood donors showed positivity for anti-HCV. Comparison of the data on HCV in the present study with data from other parts of India showed a wide variation in the different centers. The higher prevalence of HCV among CRF patients and thalassaemics indicates the need for screening of the blood units for anti-HCV before transfusion to these high risk patients.