Co-Infection with HBV, HCV & HDV
SUPPRESSION OF HEPATITIS B AND HEPATITIS C VIRAEMIA BY CONCURRENT DELTA VIRUS INFECTION : ITS BENEFICIAL EFFECT ON THE OUTCOME OF ORTHOTOPIC LIVER TRANSPLANTATION
Sanjiv Saigal Dr, Heather M Smith Ms, Institute of Liver Study, Acad Coll Hospital, London United Kingdom; Nigel D Heaton Mr, Liver Transplant Surg Service, King's Coll Hospital, London United Kingdom; John Devlin Dr, Institute of Liver Study, Acad Coll Hospital, London United Kingdom
Introduction: Co-existing multiple hepatitis virus infections occur in a significant proportion of patients. The sequelae of these multiple viral infections is inadequately described with their influence on the outcome of orthotopic liver transplantation (OLT) not elucidated. Methods: Forty eight patients with dual or triple viral infections, in whom a liver biopsy was available, were studied. These comprised patients with either simultaneous hepatitis B virus (HBV) and hepatitis C virus (HCV) infections (group 1, n=22), or HBV, HCV and hepatitis delta virus (HDV) infections (group 2, n=26). Of these, 8 patients in each group underwent OLT and were analysed separately for their clinical, histological and virological outcomes. Results: In the dual infection cohort (group 1), HBV DNA was present in 7/20 (35%) and HCV RNA in 10/16 (62.5%), whereas in the triple infection cohort (group 2) only 2/21 (9.5%) had detectable HBV DNA and no patient 0/21(0%) had HCV RNA viraemia (p values < 0.05). Of 39 patients with a complete serological profile, only one had concomitant HBV and HCV viraemia. No difference in histological progression was evident between the two groups with similar proportions requiring transplantation. Following transplantation, HCV recurred in four (50%) patients in group 1 and only one (12.5%) in group 2. In comparison, in a control group of transplant patients with isolated HCV infection, there was universal recurrence. There was no case of HCV related graft loss or mortality in either of the groups. Patients with recurrence either had isolated HBV or HCV, but no patient had simultaneous recurrence of the two. Conclusions: In triple virus infections, HDV infection is associated with a suppression of both HBV and HCV viraemia. This suppression of HCV replication persisted despite immunosuppression following OLT.