Expression ofintrahepatic hepatitis D viral antigen inchronic hepatitis D virus infection

Toelucidate thebiological importance of intrahepatic hepatitis D virusantigen, itsexpression wascorrelated withbiochemical andhistological inflammatory activity in98biopsyspecimens from68 patients seropositive fortotalantibody tothevirus. Seventy five specimens were positive forintrahepatic nuclear antigen forHDV antigen accompanied bycytoplasmic HDV antigen inonlyonebiopsy specimen. Thisgrouphadsignificantly higherserum transaminase activities andinflammatory activity thantheremainingcasesthatwere negative for HDV antigen. Amongthegrouppositive forHDV antigen, therewasnocorrelationbetweentheproportion ofhepatocytescontaining HDV antigen andeither serum transaminase activity or histological inflammatory indices. In22HDV antigenpositive patients who had followup biopsyspecimens takenat a medianoftwo years,the proportionwith cirrhosis increased from36%to73%.Serumtransaminase activities remainedthesameduringthis period,but theproportion of HDV antigen positive cells dropped. Followup of51patients showedthat21diedor underwent livertransplantation within threeyears. Theabsence ofanassociation between intrahepatic HDV antigenexpression and progression of histological liver damagedoesnotsupporttheviewthat HDV isdirectly cytopathic tohepatocytes.Immune mediatedmechanisms may havea roleinthepathogenesis of chronicliverdisease relatedtoHDV infection.