title: Virological and clinical characteristics of hepatitis delta virus in South Asia.
abstract: OBJECTIVE
  There is a paucity of data on the impact of hepatitis D virus (HDV) in patients with hepatitis B virus (HBV) infection from South Asia. We studied the impact of HDV co-infection on virological and clinical characteristics.
  
  
  METHODS
  We collected data of 480 patients with HBsAg positive and a detectable HBV DNA PCR, who presented to the Aga Khan University, Karachi and Isra University in Hyderabad, Pakistan in the last 5 years. HDV co-infection was diagnosed on the basis of anti-HDV. ALT, HBeAg, HBeAb and HBV DNA PCR quantitative levels were checked in all patients. We divided all patients into two groups based on anti-HDV, and compared their biochemical, serological & virological labs and clinical spectrum. Clinical spectrum of disease included asymptomatic carrier (AC), chronic active hepatitis (CAH), immuno-tolerant phase (IP), and compensated cirrhosis (CC).
  
  
  RESULTS
  HDV co-infection was found in 169 (35.2%). There were 164 (34.6%) HBeAg positive and 316 (65.4%) HBeAg negative patients. Mean ALT level was 66 ± 73 IU. 233 (48.5%) had raised ALT. HBV DNA level was ≥ 10e5 in 103(21.5%) patients. Overall, among HBV/HDV co-infection, 146/169 (86.4%) had suppressed HBV DNA PCR as compared to 231/311 (74.3%) patients with HBV mono-infection; p-value = 0.002. Among HBeAg negative patients 71/128(55.5%) had raised ALT levels among HBV/HDV co-infection as compared to 71/188 (37.8%) with HBV mono-infection (p-value = 0.002); levels of HBV DNA were equal in two groups; there were 27/128 (21%) patients with CC among HBV/HDV co-infection as compared to 23 (12%) in HBV mono-infection (p-value = 0.009); there were less AC (p-value = 0.009) and more CAH (p-value = 0.009) among HBV/HDV co-infection patients. Among HBeAg positive patients, serum ALT, HBV DNA levels and the spectrum of HBV were similar in the two groups.
  
  
  CONCLUSIONS
  HBV/HDV co-infection results in the suppression of HBV DNA. A fair proportion of HBV/HDV co-infected patients with HBeAg negative have active hepatitis B infection and cirrhosis as compared to those with mono-infection.
authors.affiliation: Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital, Stadium Road, PO Box # 74800, Karachi, Pakistan. khalid.mumtaz@aku.edu
authors.forename: Khalid
authors.initials: K
authors.lastname: Mumtaz
authors.forename: Umair S
authors.initials: US
authors.lastname: Ahmed
authors.forename: Sadik
authors.initials: S
authors.lastname: Memon
authors.forename: Ali
authors.initials: A
authors.lastname: Khawaja
authors.forename: Muhammad T
authors.initials: MT
authors.lastname: Usmani
authors.forename: Tariq
authors.initials: T
authors.lastname: Moatter
authors.forename: Saeed
authors.initials: S
authors.lastname: Hamid
authors.forename: Wasim
authors.initials: W
authors.lastname: Jafri
mesh_terms: D000328:Adult; D015897:Comorbidity; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006508:Hepatitis Antibodies / Q000097:blood; D006509:Hepatitis B / Q000150:complications* / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics; D003699:Hepatitis D / Q000453:epidemiology* / Q000821:virology*; D003698:Hepatitis Delta Virus / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification*; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D019562:Viral Load
chemical_list: D004279:DNA, Viral; D006508:Hepatitis Antibodies; D006513:Hepatitis B e Antigens