title: [Hepatitis B; sometimes co-infection with hepatitis D].
abstract: BACKGROUND
  The Hepatitis delta virus (HDV) is a defect RNA virus that requires the presence of the hepatitis B virus (HBV) for cellular infection. Worldwide, 350 million people are infected with HBV; 5% of these are superinfected with HDV. A chronic superinfection with HDV has a higher morbidity and mortality rate. It is clinically difficult to differentiate between an HBV and an HDV infection. Diagnosis is made via detection of HDV antibodies and HDV-RNA using PCR techniques. The only treatment option is peginterferon-alpha 180 μg subcutaneously once a week for 48 weeks.
  
  
  METHODS
  A 37-year-old man with a Syrian background and a chronic HBV infection presented with high levels of ALT indicating severe hepatitis. The level of detected HBV-DNA-particles was low, however, indicating that the HBV infection alone could not be responsible for the inflammation. Further investigations revealed a superinfection with HDV. The patient was successfully treated with peginterferon-alpha.
  
  
  CONCLUSIONS
  Severe hepatitis (high ALT level) in combination with a low HBV-DNA-particle level can indicate a HDV superinfection.
authors.affiliation: Rijnstate, afd. Maag-, Darm- en Leverziekten, Arnhem, the Netherlands.
authors.forename: Monique H M
authors.initials: MH
authors.lastname: Derikx
authors.forename: B W Marcel
authors.initials: BW
authors.lastname: Spanier
authors.forename: Jan Maarten
authors.initials: JM
authors.lastname: Vrolijk
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D004279:DNA, Viral / Q000032:analysis; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D019701:Hepatitis D, Chronic / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D008297:Male; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000032:analysis; D015163:Superinfection / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D012367:RNA, Viral