Delta Infection and Liver Disease in Hemophilic Carriers of Hepatitis B Surface Antigen

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Abstract
The prevalence of infection with hepatitis B virus (HBV)-associated delta (δ) agent was assessed in 277 treated hemophiliacs (primarily adolescents and adults) and 24 treated hemophilic children. Hemophiliacs who carry hepatitis B surface antigen (HBsAg) are at high risk of δ infection. Antibody to δ (anti-δ) was found in 14 (49070) of 29 HBsAg-positive adult or adolescent hemophiliacs and four (25%) of 16 HBsAg-positive hemophilic children; it was identified in none of the patients without serologic evidence of exposure to HBV and only occasionally and in low titers in hemophiliacs convalescent from HBV infection. Either histologic or biochemical evidence of chronic hepatitis was found in 10 (56%) of 18 HBsAg-positive hemophiliacs with anti-δ. In two patients with anti-c a potentially pathogenic role for δ was suggested by the intrahepatic expression of δ antigen, detected by immunofluorescence. It appears that δ infection is a major cause of chronic liver disease in hemophiliacs.