Journal
JOURNAL OF HEPATOLOGY
Volume 52, Issue 5, Pages 658-664Publisher
ELSEVIER
DOI: 10.1016/j.jhep.2009.10.036
Keywords
Hepatitis delta virus; Hepatitis B virus; Chronic delta infection; HDV-RNA quantification; Real-time PCR; Dynamic replicative profiles
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Funding
- Spanish Ministry of Health and Consumer affairs [FIS-PI 06-1512, FIS-PI 06-1244]
- ViRgil network of excellence [ViRgil LSHM-CT-2004-503359]
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Background & Aims: This study presents a real-time reverse-transcription PCR (rt-RT-PCR) assay for hepatitis delta virus (HDV) RNA quantification, designed to clarify the interplay between HDV and hepatitis B virus (HBV) in chronic infection. Methods: Serum HDV-RNA and HBV-DNA were analysed by rt-RT-PCR in a cross-sectional study of 37 untreated chronic HDV patients, 25 of whom were also longitudinally studied. Results: In the cross-sectional study, both viruses were active in 15 (40.5%) patients and inactive in 4 (10.8%); HDV alone was active in 12 (32.4%) and HBV in 6 (16.2%). The longitudinal study showed seven replication profiles, with considerable fluctuating activity of one or both viruses, including alternating predominance. In 20% of cases, longitudinal HBV/HDV viral loads differed from cross-sectional results, indicating a risk of misinterpreting HBV/HDV interactions when assessing a single determination. Fluctuating HBV replication only increased in the presence of fluctuating HDV activity. HBsAg levels, stable in HBV single infection, fluctuated in HDV chronic infection. The results of both the cross-sectional and longitudinal study call into question the major suppressor effect of HDV over HBV, revealing an important role of HBV. Conclusions: Longitudinal evaluation of viremia shows a complex interaction between HBV and HDV and is essential to understand the pathophysiology of chronic HDV infection. (C) 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
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