Serological Perspectives on Hepatitis B and D

Abstract

The common viral infections of the liver are allmajor world health problems, but, at a global level, hepatitis B remains the most serious. Apart from ~e general array of acute hepatitis Binfections, ranging from asymptomatic to fulminant, there .~e be!Ween 250 and 300 million carriers of hepatitis B in the world', of whom a high proportion either h~ve o~ will develop chronic complications, incl~~ng clIThosis and hepatoma-. Furthermore, hepatitis. D (delta) may co-infect or superinfect those w~t~ hepatitis B, potentiating severe or~t~~patitis and/or rapidly progressive chronic hep?tItIs and cirrhosis3• The currently available vaccines now provide the means to reduce and perhaps eventually eliminate hepatitis B induced liver cancer, although the task is a daunting one because of the scale. of the problem, the cost of the vaccine and the high incidence of hepatitis B infection in the Third World countries1,2. Most hepatitis B infections. in s~ch countries occur by vertical transmission, Infection generally occurring at birth or occasionally fetally. However a significant number of cases ~nd the majority of cases in low incidence areas are infected by either parenteral inoculation or by heterosexual or homosexual intercourse. Between 10 and 60% of homosexuals have evidence of past or present hepatitis Binfection4-6. Sexual transmission probably accounts for many of those cases where no direct parenteral route can be identifiedv. This article is an update on hepatitis Band hepatitis D serology, much of it based on perso~al experience. It does not present every serological POssibility-other factors, race, transrrU:>sion patt~, mutations of the virus genome and Infection WIth other agents for example, may influence hepatitis B virus (HBV) serology. Indeed, because the ~igh risk groups for hepatitis. B a~d human ~unodeficiency virus (HIV) Infection are so SImilar and because it is now known that HIV infection can alter hepatitis B and hepatitis D serologyS, it is very important that the latter Consideration be especially taken into account.