The relationship between serum HBV DNA and HDV RNA levels, histological findings and clinical phases of disease in patients with chronic HDV

Background and aim: Hepatitis delta virus is a defective RNA virus and it certainly requires hepatitis B virus in terms of viral replications. Chronic Hepatitis B and D virus infections have a wide clinic spectrum beginning from asymptomatic carriers continuing with chronic active hepatitis B, liver cirrhosis and hepatocelluler carcinoma. However, the mechanism causing this clinical spectrum is still cannot be understood. In our region, hepatitis delta virus is common and still continuing to be a serious problem. In this study, our aim is to analyze biochemical, haematological, virological, serologic, histological parameters correlating with the disease progression and to investigate the relationship between the disease progression, HBV DNA and HDV RNA levels obtained through quantitative PCR method.Material and method: 220 patients were analyzed prospectively in this study. The patients were divided into three groups: ones who have cirrhosis depending on hepatitis delta virus (Group 1), chronic delta hepatitis (Group 2), chronic hepatitis B (Group 3). Initially, biochemical, haematological, virological and serological variables of patients were studied. Liver biopsy was planned to perform in all chronic hepatitis B and D patients for histological analysis. Ishak histological activitity index was used for histological scoring. HBV DNA, HDV RNA levels were also studied through quantitative PCR method. Results of three groups were compared.Results: Group 1 included 44 patients( %20), group 2 included 86 patients( 39.09%), and group 3 included 90 patients (40.9%). It was found out that cirrhotics and chronic hepatitis D sufferers had significantly less level of HDV DNA when compared to the group with chronic hepatitis B. The levels of albumin, haemoglobin and leukocyte count in cirrhotics patients were significantly low. There was no significant difference among three groups in terms of HBsAg titres, ALT, serum iron, serum iron binding capacity and GGT values. The levels of ferritin and AFP was found significantly high in patients with cirrhosis when compared to the other two groups. In group of cirrhotic patients, in terms of time AST and protrombin time was found significantly high when compared to group with hepatitis B virus. In terms of alkalen phosphates there was no significant difference between group 1 and group 2; but it was significantly high in group 1 and 2 when compared to group 3. Platelet levels were significantly low in group 2 when compared to group 3. There was significant difference between group 1 and group 3 in terms of creatinine, glucose, and LDH. Globulin levels were significantly high in group 1 when compared to either the second or the third group; and it was higher in the second group when compared to the third one. There was a significant difference among three groups in terms of total bilirubine levels.Conclusions: In chronic hepatitis delta virus infections, serum HBV DNA level is lower due to the suppressive effects of hepatitis delta virus. There was no difference between chronic hepatitis D patients with or without cirrhosis in terms of serum HDV RNA levels. There is a correlation between serum HDV RNA and stage of fibrosis, ALT and necroinflamation scores in patients with chronic hepatitis D. In addition, there are correlations between ALT/AST and necroinflamation scores and serum HBV DNA levels in patients with chronic hepatitis B. Histologically, patients with chronic hepatitis D have more severe disease according to higher score of necroinflamation and a more advanced fibritik stage. There is a correlation between ferritin, total globulin, AFP levels and severity of the disease. It can be useful to take into consideration these findings while following and treating patients with chronic HDV.Key Words: Hepatitis delta virus, Real Time PCR, hepatitis B virus, HDV RNA, HBV DNA.