infecţio
ro
studii clinice
Studiul interferenţei
HDV-HBV la pacienţii
cu dublă infecţie din Bucureşti.
Implicaţii clinice
Gabriel Adrian Popescua
b
, Dan Oţelea
a
,
Mihaela Tinischi
a
, Ionel Iosif
c
, Cristina Popescu
a, b
,
Elisabeta Benea
a, b
, Adrian Streinu-Cercel
a, b
a. Institutul Naţional de Boli Infecţioase
„Prof. dr. Matei Balş”
b. Universitatea de Medicină şi Farmacie
„Carol Davila” Bucureşti
c. Institutul de Sănătate Publică Bucureşti
Abstract
A viral replicative interference between hepati- significant level (> 104 copies/ml) was less frequent
tis B virus (HBV) and hepatitis delta virus (HDV) in anti-HDV positive group: 18.39% versus 33.33%
with HDV dominance seems to exist; we studied the patients. The detection rate of HDV RNA among
extent of this interference. The clinical outcome of anti-HDV-positive patients was 43.05% versus only
chronic HBV hepatitis is worse with a dual infec- 2.68% in control group (p=0.0001). HBV replication
tion HBV-HDV; we would to evaluate if a replica- was not different in the HDV viremic and non-vire-
tive HDV infection is a supplemental risk factor for mic patients from study group: 22.1% versus 24.2%.
these patients. Methods: The study took place at All clinical parameters analyzed were more altered
Matei Bals Infectious Diseases National Institute in anti-HDV positive group; clinical parameters
(Bucharest, Romania), between June 2006 and De- were more altered for HDV viremic versus HDV
cember 2006. We included 223 chronic HBV infected nonviremic patients: elevated ALT values: 58.95%
patients positive for anti-HDV assay. Controls con- versus 28.91% (OR 3.40; p=0.00001), thrombocyto-
sisted of 112 patient’s chronic HBV monoinfected. penia (OR 2.22; p=0.003), decreased prothrombin
The interactions among HDV and HBV were stud- index (OR 2.01; p=0.03), but not for end-stage liver
ied by measuring HBV-DNA and HDV-RNA levels. disease: 18.95% versus 10.93% (OR 1.90; p=0.09).
Clinical data were collected for both groups: ALT Conclusion: HDV is acting as “dominant” virus
level, thrombocytopenia, prothrombin level, and in dual infection HBV-HDV: HBV replication is less
severe liver disease. Results: From study group, 179 frequent and at lower levels as in HBV monoinfect-
patients (80.27%) were viremic for at least one vi- ed patients. Clinical parameters are worse in anti-
rus, and 61 patients had dual viremia of HBV/HDV HDV patients, and worst in those HDV viremic. Less
(27.35%). HBV viremia was reported in 64.57% than half anti-HDV positive patients are HDV vire-
patients in study group and in 81.11% patients in mic, raising the question of optimal treatment for
control group (p=0.006); difference is conserved those with only HBV replicative infection.
for naïve treatment patients from both groups: Keywords: HBV, HDV, viral replicative interfe-
67.33% versus 86.21% (pYates=0.001). HBV-DNA rence
pag. 16
nr. 4/decembrie 2007
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