Z Gastroenterol 2006; 44 - P242
DOI: 10.1055/s-2006-950839

Significance of HBsAg and HDVRNA levels in patients with delta hepatitis recruited in the Hep-Net/International HDV intervention trial

K Zachou 1, C Yurdaydin 2, U Drebber 3, G Dalekos 4, A Erhardt 5, Y Cakaloglu 6, H Degertekin 7, S Gurel 8, S Zeuzem 9, H Bozkaya 2, V Schlaphoff 1, HP Dienes 3, T Bock 10, MP Manns 1 H Wedemeyer 1, For the International Delta Hepatitis Study Group
  • 1Medizinische Hochschule Hannover, Gastroenterologie, Hepatologie und Endocrinologie, Hannover, Germany
  • 2University of Ankara Medical School, Gastroenterology Section, Ankara, Turkey
  • 3University of Cologne, Institute of Pathology, Cologne, Germany
  • 4Medical School, University of Thessaly, Department of Internal Medicine (Academic Liver Unit and Research Laboratory of Internal Medicine), Larissa, Greece
  • 5Heinrich-Heine University, Department of Gastroenterology, Hepatology and Infectious Diseases, Dusseldorf, Germany
  • 6University of Istanbul Medical School, Gastroenterohepatology Section, Istanbul, Turkey
  • 7Dicle University Medical School, Gastroenterology Section, Diyarbakir, Turkey
  • 8Uludag University Medical School, Gastroenterology Section, Bursa, Turkey
  • 9Saarland University Hospital, Department of Internal Medicine II, Homburg/Saar, Germany
  • 10University of Tuebingen, Institute of Pathology, Tuenbigen, Germany

Aims: Hepatitis delta virus (HDV) infection is associated with severe liver disease with limited treatment options. We investigated the significance of HDV-RNA, HBsAg and HBV-DNA levels and analysed histological, biochemical and demographic parameters in patients recruited in an International-multicenter intervention trial.

Methods: 91 patients with chronic HDV infection were randomized (39 in Turkey, 43 in Germany and 9 in Greece). 85 sera were available for HDV-RNA, HBsAg and HBV-DNA quantification. Blinded histological grading and staging (Ishak-score) was performed by the Hep-Net central pathologist.

Results: 57 patients (63%) were male, median age 38 years (range 17–62) and 15% tested HBeAg positive. Demographic, clinical and laboratory characteristics of the patients did not differ in respect to country of origin. HDV viremia ranged from <120 to 8,4×107 copies/ml (median 5,8×105). The majority of the patients (52%) showed high HDV-RNA and low HBV-DNA levels. Only 4 patients (5%) had high HBV-DNA and low HDV-RNA levels. HDV-RNA was correlated positively with HBsAg levels (p=0.002) and negatively with age (p=0.023). HBsAg levels were correlated negatively with age (p=0.002) and positively with grading (p=0.019). The mean histological grading and staging scores were 3.2±1.3 and 7.3±2.17, respectively. Only gGT was independently associated with staging (p=0.032). No parameter was independently associated with histological grading. HBsAg expression in liver tissue was associated with higher HBV-DNA levels (p=0.002), lower gGT levels (p=0.015), higher albumin levels (p=0.043) and HBeAg positivity (p=0.029). Patients with HBcAg expression in liver tissue had lower grading scores (p=0.003) and HBsAg levels in serum (p=0.033).

Conclusions: In chronic HDV infection, biochemical parameters may not reliably indicate the stage of the disease and thus liver biopsy is required. HDV viremia is highly variable, is negatively correlated with HBV replication and is not related to biochemical activity or histological grading and staging, suggesting that HDV is non-cytopathic. Thus, immune responses are likely to play the major role in the pathogenesis of delta hepatitis.