Clinical and biological features in chronic hepatitis D

Abstract

Introduction: Infection with hepatitis D virus (HDV) has a worldwide distribution, but areas of high prevalence include the Mediterranean Basin, inclusively Moldova. Most of the patients have progressive deterioration of liver function and increased risk of liver cirrhosis and end-stage of liver failure. Purpose and objectives: To evaluate clinical features, paraclinical results and laboratory peculiarities of liver function in patients with chronic hepatitis D, in comparison with chronic hepatitis B patients. Material and methods: Thirty-six patients, twenty with chronic HDV infection, with median age of 40.2 years, and other 16 with chronic HBV infection, with median age of 43,3 years, were investigated consecutively. Results: The clinical presentation of patients with chronic hepatitis D shows the predominance of astheno-vegetative syndrome (100%), dull pain in right upper quadrant (83%), hepatomegaly (60%) and splenomegaly (33%). In patients with HDV was found veridical pronounced cytolytic syndrome, manifested by increase of ALT (97.55+8.5 U/l) and AST (78.83+6.2 U/l) compared with control group (p<0.001) and patients with HBV (p<0.05), also was determined tendency towards reduction of prothrombin and albumin compared with chronic hepatitis B. Research blood count revealed a white blood cell (3.6+0.57 x 109/1) and platelet counts (156.8+10.2 x 109/1) decreased truthful in HDV versus the control group (p<0.01), as well as to patients with HBV (p<0.05). In HDV patients we have detected the presence of HBsAg, anti-HBcor and anti-HDV in all patients (100%), HBeAg - in 30% of patients, anti-HBe - in 70%. The HDV RNA was found present in all investigated patients with chronic hepatitis D, a low titre of HBV DNA was detected in 5 (25%) patients. Chronic hepatitis D patients had high viral level of HDV RNA, on average of 514038 IU/ml. Most of them had a negative HBV DNA - 76%, and just 24% had parallel HBV DNA and HDV RNA. Conclusions: In patients with HDV infection was observed a higher frequency of clinical and paraclinical symptoms versus HBV alone, a more evident cytolytic syndrome, leukopenia and thrombocytopenia, (p<0.01). The majority of patients with chronic hepatitis D, have high viral level of HDV RNA, and therefore they require antiviral treatment.