Single center experience related to chronic hepatitis with hepatitis B and D virus infections

Abstract Aim. To present follow-up results of our chronic hepatitis patients infected with HDV treated with subcutaneous interferon (IFN). Method. A total of 24 patients, 21 males and 3 females with HBsAg (+), AntiHBc IgM (-), antibody against hepatitis D virus (anti HDV) and/or HDV RNA (+) and with above normal values for serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST), who had no contraindications for treatment and had suitable histological activity index (HAI) and fibrosis scores in their liver biopsies were enrolled. Patients treated with three doses of 9-10 MU subcutaneous IFN per week. Serum aminotransferases, HBsAg, antibody against HbsAg (anti HBs), hepatitis B e antigen (HBeAg), antibody against HBeAg (anti HBe), HBV DNA, anti HDV and/or HDV RNA levels were determined before, during and after treatment. Results. Nine patients (37.5%) stopped treatment in an early phase. In 3 patients (12.5%), treatment was discontinued due to severe side effects. In the post-treatment period, HBV DNA was negative in all patients. In 4 patients who completed 12-month treatment (33.3%), ALT levels decreased to normal values in the 3rd month and this level was sustained during follow-up of 24 months; in one patient, ALT levels mildly increased in the 6th and 12th months and decrease to normal values were observed in the following visits. Conclusions. High dose interferon, a proinflammatory cytokine with antiviral efficacy and biological activity spectrum, seems as an effective agent in treatment of chronic hepatitis D. In addition, use of pegylated IFNs with higher and sustained serum levels may be more promising as compared to classical IFN treatment. Keywords: Hepatitis delta virus, chronic active hepatitis, interferon alpha, HBsAG, antiHBs Ozet Amac. HDV ile enfektia kronik hepatit hastalarimizin cilt alti interferon tedavisi sonrasi takip sonuclarini sunmak. Yontem. Toplam 24 hastanin (21 Erkek, 3 Kadin) HBsAg (+), AntiHBc IgM (-), hepatit D virusune karsi antikor (anti HDV) ve/veya HDV RNA (+) ve karaciger transaminazlari normalden ust seviyedeydi. Bu hastalarin tedavi icin kontraendikasyonlari yoktu hastalarin uygun histolojik aktivite endeksleri ve karaciger biyopsilerinde fibrozis skorlari kaydedildi. Hastalar haftada 3 doz 9-10 MU cilt alti interferon ile tedavi edildi. Serumaminotransferzlari HBsAg, anti HBs, HBeAg, anti HBeAg, HBV DNA, anti HDV ve/veya HDV RNA seviyeleri tedaviden once tedavi esnasinda ve sonrasinda belirlendi. Bulgular. Dokuz hasta (%37,5) tedaviyi erkan safhada durdurdu. Uc hasta (%12,5) tedavi ciddi yan etkilerden dolayi birakildi. Tedavi sonrasi donemde HBV DNA'si tum hastalarda negatifdi. Oniki aylik tedaviyi tamamlayan 4 hastada (%33,3) ALT seviyeleri 3. ayda normal degerlere dustu ve 24 aylik takip suresince bu seviyeyi korudu; bir hastadan ALT seviyeleri hafifce artti 6. ve 12. aylarinda hafifce yukseldi sonrasi kontrollerinde normal seviyelerine dustugu goruldu. Sonuc. Anti viral etkinligi ve biyolojik aktivite spektrumu olan proinflamatuvar sitokin olan yuksek doz olan interferonun kronik hepaptit D'nin tedavisinde etkin bir ajan oldugu gorulmektedir. Ilave olarak, yuksek ve sabit serum seviyelerinde polietilen glikol ile kaplanmis interferonun kullaniminin klasik interferon tedavisi ile kiyaslandiginda daha umit vericidir. Anahtar sozcukler: Hepatit delta virusu, kronik aktif hepatit, interferon alfa, HBsAg, antiHBs