Virological Responses Evaluated During Antiviral Therapy in Chronically Infected HBV and HDV Patients

The aim of thisinvestigation was to evaluate the various virological responses at several time points of therapy in chronically infected patients with dual HBV and HDV infection.A total of 23 patients, 8 (34.8%) women and 15 (65.2%) men with serologically proved chronic HBV and HDV infection, at the Gastroenterology Department of the University Hospital St. Marina, Varna, Bulgaria, were investigated in the hospital's laboratories of Clinical Virology and Clinical Immunology. Quantitative determination of HBV DNA and HDV RNA was performed by Real-time PCR, on several occasions during and after therapy from 2012 to 2017.HBV viremia ranged from 1.0x10 2to 1.6x106cps/ml. HDV viremia ranged from 2.5x102 to 9.6x106cps/ml. HDV replication dominated in 16 patients (69.6%), accompanied by low HBV viremia. HDV-RNA and HBV-DNA levels showed no direct inverse correlation in the less part of the investigated patients, although higher HDV levels were accompanied by lower HBV viremia. HBV DNA correlates positively with HBeAg positivity. IFN is efficient in reducing transaminanses (ALT), decreasing HDV RNA levels at some point, but it is not operative in HDV RNA clearance. Lamivudine alone is a potent inhibitor of HBV DNA replication but does not improve disease activity or lower HDV RNA levels in patients with chronic delta hepatitis. It did not increase sustained virological response when combined with IFN. When virological breakthrough during Lamivudine therapy occurs, Tenofovir is a means of choice for treatment. Biochemical parameters did not accurately indicate the stage and grade of liver disease in chronic HDV patients as they often fluctuate over time.