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Indian Journal of Medical Microbiology, Vol. 23, No. 2, April-June, 2005, pp. 141-142 Letter To Editor Need for Routine Screening of HBV and HDV in Patients with Cirrhosis of the Liver Gupta P, Biswas D, Shukla I, Bal A Department of Microbiology, Himalayan Institute of Medical Sciences, Dehradun Correspondence Address:Department of Microbiology, Himalayan Institute of Medical Sciences, Dehradun - 248 140, UP, varshneyhm@sancharnet.in Code Number: mb05039 Dear Editor, Three hundred million persons worldwide carry HBV and of them, at least 5% have delta hepatitis.[1] HDV is a delta agent that is deformed and incomplete RNA virus whose replication is dependent on the presence of HBsAg. In association with HBV, HDV produces significantly more severe illness than HBV alone. In the present study, the prevalence of HBV and HDV infection in cirrhosis of the liver and the impact of the dual infection on the clinical outcome in cirrhosis of the liver was assessed. The present study was conducted in the department of microbiology at JN medical college and hospital, AMU, Aligarh over a period of 12 months from1994-1995. Sixty-nine consecutive patients of cirrhosis of liver admitted in the medical ward of the hospital during that period were included in the study. The diagnosis of cirrhosis was established as per the criteria described previously.[2] In addition to assessing the hepatic function, the study samples were also screened for HBsAg and for IgM anti HBc (DIAGNOSYS, AG, Switzerland and MUREX DIAGNOSTICS LTD, Illinois respectively). In all those samples, which were positive for the HBV markers, anti HDV antibody titers were also tested [ETI-AB Deltak-3 (P2802) Kit manufactured by SORIN BIOMEDICA, Italy]. 28 (40.6%) of 69 patients of cirrhosis of the liver were positive for HBsAg. Of these 28, IgM anti HBc was positive in 7 (25%). Anti HDV (delta positive) was detected in 5 (17.9%) of the 28 HBV positive cases [Table - 1]. In the present study, the overall HBsAg positivity rate was 40.6% in cirrhosis of the liver. The prevalence of anti-HDV in cases of cirrhosis of the liver, positive for HBV markers was 17.9%, this is in accordance with the previous reports from other parts of North India.[3],[4] There were no significant changes in the concentrations of the hepatic enzymes in the HDV positive patients compared to the uninfected groups. In one delta positive patient, both HBsAg and IgM anti-HBc were also present, indicating it to be a case of co-infection. The other four patients with anti HDV were positive only for HBsAg, suggesting, possibly, super-infection by the delta virus. Fatality rate was much higher (60%) in delta positive than in delta negative cases (4.4%). The difference in the fatality rates between anti-delta antibodies positive and anti delta antibodies negative groups was statistically significant (P <0.001). Hepatic encephalopathy and fulminant hepatic failure were also common in HBV and HDV infected patients compared to those with HBV infection alone. However, this needs confirmation by long term follow up studies. The high HBsAg positivity rate and the prevalence of anti HDV in cirrhosis of the liver observed in the present study suggest that HDV infection is common in Aligarh. It is likely that the prevalence of HBV infection is much higher than what was observed in the present study since it is known that HDV may suppress the production of HBsAg, which is likely to be below the threshold of detection. Since the prognosis of patients with dual infections (HBsAg and HDV) is poor, we suggest screening for anti HDV in all HBsAg positive patients of chronic liver disease. Furthermore the poor prognostic outcome of dual infections also points out the importance of carrying out Universal childhood immunization against HBV to prevent the development of a more severe disease due to associated HDV infection. It is also suggested that a person who already has HBV infection, exposure to blood should be strictly avoided.[1] References
Copyright 2005 - Indian Journal of Medical Microbiology The following images related to this document are available:Photo images[mb05039t1.jpg] |
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