Splenomegaly in asymptomatic chronic carriers of hepatitis B and D viruses

Abstract

To investigate whether splenomegaly, a common and striking feature of hepatitis D virus (HDV)-related cirrhosis, is manifested in both the late cirrhotic phase and the early and asymptomatic stages of chronic HDV infection. A blind ultrasonographic study of HDV-positive and -negative hepatitis B surface antigen (HBsAg) carriers in the Community of Archangelos of Rhodes Island, Greece, where HDV infection is endemic. The ultrasonographic findings were compared with clinical, biochemical and demographic data by uni- and multivariate analysis. The study population comprised 47 HDV-positive and 78 HDV-negative asymptomatic HBsAg carriers. A maximal longitudinal diameter of the spleen of >12cm and >15cm was detected in 13 of 47 (27.7%) and three of 47 (6.4%) of the HDV-positive and in 13 of 78 (16.7%) and three of 78 (3.8%) of the HDV-negative group, respectively (P>0.1). Splenomegaly (>12cm) was associated with significant dilation of the portal vein and enlargement of the left hepatic lobe. Multivariate analysis demonstrated that in both the HDV-positive and -negative HBsAg carriers, factors associated with chronic hepatic injury and/or biochemical markers of liver necro-inflammation correlated significantly with splenomegaly and could explain most of the variability in splenic size, particularly in the HDV-positive group. Although splenomegaly is more frequent and pronounced in chronic liver disease due to HDV than in HBV disease alone, it does not appear to be a feature specific to chronic HDV infection. The main determinants of splenic enlargement in the present field study of HBsAg carriers were found to be liver necro-inflammation and ultrasonographic indices of portal hypertension, regardless of the presence or absence of HDV infection.