Delta agent infection: an unfavourable event in HBsAg positive chronic hepatitis

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Abstract
ABSTRACT— To investigate the clinical value of delta agent infection in HBsAg positive chronic hepatitis, we detected anti‐delta antibody (anti‐δ) in serum and delta antigen (δ‐Ag) on sequential liver biopsies of nine patients with HBsAg‐positive CPH and 45 patients with HBsAg‐positive CAH without cirrhosis observed for at least 2 years. The initial group of patients with CAH was composed of 54 patients who were consecutively either left untreated or treated with 15 mg of prednisolone daily. Nine patients dropped out. δ‐Ag was searched by the direct immunofluorescence technique. HBsAg, anti‐δ, HBeAg and anti‐HBe were detected by RIA.All CPH patients were δ‐Ag negative in the 1st liver biopsy and anti‐δ negative in serum. Out of these nine patients, seven remained δ‐Ag negative CPH throughout the observation and the remaining two became δ‐Ag positive, anti‐δ positive and developed CAH.The 73% of patients with CAH were δ‐Ag positive on the 1st biopsy and anti‐δ positive in serum. The patients in the δ‐Ag positive group (24 were always δ‐Ag positive and two became δ‐Ag positive during the observation) more frequently than those in the δ‐Ag negative group (10 were always δ‐Ag negative and nine became δ‐Ag negative during the study) showed deterioration or died (77 vs. 16%; P<0.001). Neither in the δ‐Ag positive group nor in the δ‐Ag negative group did prednisolone modify the course of the disease. The δ‐Ag positive compared to the δ‐Ag negative patients were anti‐HBe positive more frequently and circulated HBeAg less frequently. The presence or absence of HBeAg and anti‐HBe in serum was not correlated to a type of outcome.