The Prevalence and Clinical Characteristics of Hepatitis-delta Infection in Korea / 대한간학회지

BACKGROUND/AIMS: The prevalence of hepatitis delta virus (HDV) infection has been estimated as being approximately 5% among global HBsAg carriers. The anti-delta positive rate in Koreans had been reported as being 0.85% in 1985. While the prevalence of HBV has been decreased from nearly 10% to 5% during the past twenty years, there have been no more studies on the anti-delta prevalence in Koreans. The aim of this study was to estimate the anti-delta prevalence in Koreans and to study the clinical characteristics of anti-delta positive patients in a single center. METHODS: Serum anti-delta was measured in one hundred ninety four HBsAg-positive patients who were admitted to our hospital from February 2003 to August 2003. We checked the genotypes of the HBV in the anti-delta positive patients. The clinical features of the anti-delta positive patients were compared to those clinical features of the anti-delta negative patients from the aspect of age, gender, mode of transmission, the positivity of HBeAg and serum HBV DNA. RESULTS: Serum anti-delta was positive in seven patients among the 194 subjects, giving a 3.6% positive rate. Among these seven patients, six had hepatocellular carcinoma (HCC) and the other one had cholangiocarcinoma. All of the anti-delta positive patients had the C genotype of HBV. The anti-delta positive patients showed significantly suppressed HBV DNA replication compared to the anti-delta negative patients. CONCLUSIONS: In Koreans, anti-delta was positive mainly in HCC patients with an approximate prevalence of 4%, and this rate has not changed much for the past twenty years. HBV DNA replication was suppressed by HDV infection.

Anti-HBc IgM and anti-delta screening by EIA method

The clinical value of an enzyme-linked immunosorbent assay (ELISA) for the detection of anti-HBc IgM was evaluated by testing 202 sera from acute viral hepatitis B (AVHB), hepatitis B (HB), chronic hepatitis (CAH), chronic liver disease (CLD), cirrhosis, primary hepatoma, HBsAg carrier, acute viral hepatitis A (AVHA), hepatitis A (HA), non-A, non-B (NANB) hepatitis and miscellaneous conditions other than hepatic disease, and 19 additional various hepatic disease cases were examined for anti-delta. In clinical situations the accurate diagnosis of HB is not always possible and the differential diagnosis seems to be very important especially in making decisions of treatment and estimation of prognosis. In overall cases the highest positive rate of anti-HBc IgM was found in AVHB as shown as 74.3% (26/35) comparing to other conditions in which the positive rate was extremely low (2.1%). The anti-HBc IgM appeared to be highly specific to AVHB (83.9%) as compared to the other. The positive rate of HBsAg was high in AVHB, CAH and HBsAg carrier (100.0%) followed by CLD, cirrhosis and HB (up to 70.8%). The ALT activities and ALPalb fractions were significantly high in AVHB (p less than 0.005). The correlation between the positivity of anti-HBc IgM and highly abnormal ALT appeared be high. AVHB was confined mostly to 10-20 age group and the male to female ratio was about 6 to 1. Subgroup of AVHB II with positive anti-HBc IgM appeared to have a greater chance being positive for HBsAg and ALPalb. The S/N ratio of anti-HBc IgM was as high as 20 which was unique to AVHB.

A Preliminary Observation on Delta Antigen Infection in 35 Patients with Severe Hepatitis B / 第三军医大学学报

The paper is to report a retrospective study on delta antigen infection in 35 patients with severe hepatitis B (13 subacute and 22 chronic cases).One serum sample from each patients was collected at least 21 days (21～156 days)after the last attack of the disease,and anti-delta antigen was tested with EIA method (Abbot kit made in USA).The upper limit of O.D.value for positive resultswas calculated as 0.391.It was found that anti-delta antigen was positive in 12 cases(34.3%)out of the 35. 23.1%(3/13)of the subacute and 40.9%(9/22) of the chronic cases were positive.There were 3～5 serological parameters indicating HBV infection in each case.All the 12 positive patients were males of Han Nationality with a mean age of 34 years (a range of 19 to 51).11 were from Sichuan province and only 1 from Guizhou.3 were subacute cases without previous history of hepatitis,and aggravation of the clinical condition occurred in their course;there was a history of acute icteric hepatitis in the remaining 9 cases and 5 out of the 9 were long-term HBsAg carriers.The recent attack of the disease often showed a rapid progression to the severe stage within a month.It is suggested that delta antigen might be one of the factors leading to the aggravation of viral hepatitis.