Serological diagnosis of hepatitis B and delta virus (HBV/HDV) coinfection.
Diagnosis of acute hepatitis B virus/hepatitis delta virus (HBV/HDV) coinfection is currently based on detection of anti-HD, however this antibody may be undetectable during the acute phase of hepatitis. To evaluate the entity of misdiagnosis of HBV/HDV coinfection in acute HBsAg-anti-HBc IgM positive hepatitis we examined sera from 245 consecutive patients obtained at admission and day 30, 60, 120, 210 and 400 of their follow-up. Anti-HD was detected in the serum of 26 out of 245 patients (10.6%). In 15% of cases it was present at admission, while in 92% it was found after 30 days. The combined detection of HDV-RNA, HDAg and IgM anti-HD in acute phase sera allowed a correct etiologic diagnosis in 69% of the cases. These findings suggest that the prevalence of HBV/HDV coinfection is underestimated when anti-HD is the only marker to be detected during the acute phase of disease. A correct etiologic diagnosis can only be made by testing acute phase sera for all the available markers of HDV. However, the best cost-effective procedure is to test any patient with HBV markers at presentation for anti-HD, 30-40 days after the onset of symptoms.
Salassa
B
B
Division of Infectious Diseases, Amedeo di Savoia Hospital, Torino, Italy.
Daziano
E
E
Bonino
F
F
Lavarini
C
C
Smedile
A
A
Chiaberge
E
E
Rosina
F
F
Brunetto
M R
MR
Pessione
E
E
Spezia
C
C
D000328:Adult; D005260:Female; D006509:Hepatitis B / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D006514:Hepatitis B Surface Antigens / Q000032:analysis / Q000276:immunology; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D003699:Hepatitis D / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D003698:Hepatitis Delta Virus / Q000235:genetics / Q000276:immunology; D006801:Humans; D015151:Immunoblotting; D007075:Immunoglobulin M / Q000032:analysis / Q000276:immunology; D008297:Male; D009693:Nucleic Acid Hybridization; D015347:RNA Probes; D012367:RNA, Viral / Q000032:analysis / Q000235:genetics; D011863:Radioimmunoassay; D012698:Serologic Tests
D006514:Hepatitis B Surface Antigens; D007075:Immunoglobulin M; D015347:RNA Probes; D012367:RNA, Viral