title: Chronic HDV/HBV co-infection: predictors of disease stage---a case series of HDV-3 patients.
abstract: OBJECTIVE
  Chronic HDV/HBV co-infection is perhaps the most intriguing amongst all viral hepatitis. Only few studies focus deeply on this topic, particularly with patients infected with HDV-3. This study aimed to identify predictors of advanced disease, examining a cross-sectional data of 64 patients.
  
  
  METHODS
  Histological grading was used to characterize the disease stages and viral loads were tested as predictors of necroinflammatory activity and fibrosis.
  
  
  RESULTS
  We identified three HDV/HBV co-infection patterns: patients with predominant HDV replication (56.3%), patients with similar viral loads of both viruses (40.6%), and patients with predominant HBV replication (3.1%). Mean HDV-RNA showed a positive trend regarding inflammatory activity and grade of fibrosis. HDV viral load correlated positively with serum levels of liver enzymes and inversely with platelets count. HBV viral load showed no correlation with any of the above parameters. Advanced fibrosis was associated with age, splenomegaly, and HDV viral load of more than 2 log10. Multiple logistic regression confirmed the independent effect of HDV viral predominance. Advanced necroinflammatory activity was independently associated with HDV viral load and splenomegaly.
  
  
  CONCLUSIONS
  HDV may possibly play an important and direct role in the establishment of necroinflammatory activity and fibrosis. Data show an indigenous HDV genotype, HDV-3, similar to those described in the Amazon region.
authors.affiliation: Virology Department, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil. Electronic address: wornei.braga@hotmail.com.
authors.forename: Wornei Silva Miranda
authors.initials: WS
authors.lastname: Braga
authors.affiliation: Virology Department, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil; Multidisciplinar Center, Federal University of Amazonas, Manaus, Amazonas, Brazil.
authors.forename: Cintia Mara Costa
authors.initials: CM
authors.lastname: de Oliveira
authors.affiliation: Anatomopatology Department, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.
authors.forename: José Ribamar
authors.initials: JR
authors.lastname: de Araújo
authors.affiliation: Virology Department, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.
authors.forename: Marcia da Costa
authors.initials: Mda C
authors.lastname: Castilho
authors.affiliation: Virology Department, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.
authors.forename: Joelma Martins
authors.initials: JM
authors.lastname: Rocha
authors.affiliation: Virology Department, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.
authors.forename: Joao Bosco de Lima
authors.initials: JB
authors.lastname: Gimaque
authors.affiliation: Virology Department, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.
authors.forename: Maria Luana Cristiny Rodrigues
authors.initials: ML
authors.lastname: Silva
authors.affiliation: Virology Department, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.
authors.forename: Heline Lira
authors.initials: HL
authors.lastname: Vasconcelos
authors.affiliation: Virology Department, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil; Nilton Lins University, Manaus, Amazonas, Brazil.
authors.forename: Rajendranath
authors.initials: R
authors.lastname: Ramasawmy
authors.affiliation: Gastroenterology Unit, Federal University of Bahia, Salvador, Bahia, Brazil.
authors.forename: Raymundo
authors.initials: R
authors.lastname: Paraná
mesh_terms: D000293:Adolescent; D000328:Adult; D000595:Amino Acid Sequence; D001938:Brazil / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D005838:Genotype; D006515:Hepatitis B virus / Q000235:genetics* / Q000502:physiology; D019694:Hepatitis B, Chronic / Q000175:diagnosis* / Q000453:epidemiology* / Q000235:genetics; D019701:Hepatitis D, Chronic / Q000175:diagnosis* / Q000453:epidemiology* / Q000235:genetics; D003698:Hepatitis Delta Virus / Q000235:genetics* / Q000502:physiology; D006801:Humans; D008099:Liver / Q000201:enzymology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D012720:Severity of Illness Index; D019562:Viral Load; D014779:Virus Replication / Q000502:physiology; D055815:Young Adult
keywords: Fibrosis; Hepatitis B and D coinfection; Hepatitis D virus; METAVIR; Viral load