• chronic hepatitis;
  • delta antigen;
  • HBsAg

ABSTRACT— To investigate the clinical value of delta agent infection in HBsAg positive chronic hepatitis, we detected anti-delta antibody (anti-δ) in serum and delta antigen (δ-Ag) on sequential liver biopsies of nine patients with HBsAg-positive CPH and 45 patients with HBsAg-positive CAH without cirrhosis observed for at least 2 years. The initial group of patients with CAH was composed of 54 patients who were consecutively either left untreated or treated with 15 mg of prednisolone daily. Nine patients dropped out. δ-Ag was searched by the direct immunofluorescence technique. HBsAg, anti-δ, HBeAg and anti-HBe were detected by RIA.

All CPH patients were δ-Ag negative in the 1st liver biopsy and anti-δ negative in serum. Out of these nine patients, seven remained δ-Ag negative CPH throughout the observation and the remaining two became δ-Ag positive, anti-δ positive and developed CAH.

The 73% of patients with CAH were δ-Ag positive on the 1st biopsy and anti-δ positive in serum. The patients in the δ-Ag positive group (24 were always δ-Ag positive and two became δ-Ag positive during the observation) more frequently than those in the δ-Ag negative group (10 were always δ-Ag negative and nine became δ-Ag negative during the study) showed deterioration or died (77 vs. 16%; P<0.001). Neither in the δ-Ag positive group nor in the δ-Ag negative group did prednisolone modify the course of the disease. The δ-Ag positive compared to the δ-Ag negative patients were anti-HBe positive more frequently and circulated HBeAg less frequently. The presence or absence of HBeAg and anti-HBe in serum was not correlated to a type of outcome.