0270-9139/84/0406-1111$02.00/0 zyxwvutsrqpon HEPATOLOGY zyxwvutsrqponmlk Copyright zyxwvutsrqpo 0 1984 by the American Association for the Study of Liver Diseases Vol. 4, No.6, pp. 1111-1115, 1984 zy Printed zyx in U.S.A. Hepatitis B Markers in United States Drug Addicts with Special Emphasis on the Delta Hepatitis Virus ANTONIO PONZETTO, LEONARD B. SEEFF, ZELMA BUSKELL-BALES, KAMAL G. ISHAK, THE VETERANS ADMINISTRATION HEPATITIS COOPERATIVE STUDY GROUP JAY H. HOOFNAGLE, HYMAN J. ZIMMERMAN, ROBERT H. PURCELL, JOHN L. GERIN AND The Division zyxwvuts of Gastroenterology, Ospedale Molinette, Torino Italy; The Veterans Administration Medical Center and Georgetown University School of Medicine, Washington, D.C.; The Armed Forces Institute of Pathology, Washington, D.C.; The Liver Diseases Section, National Institutes of Arthritis, Diabetes and Digestive and Kidney Diseases; George Washington University School of Medicine, Washington, D.C.; and the National Institutes of Allergy and Infectious Diseases, NIH, Bethesda, Maryland Hepatitis B virus and hepatitis delta virus co-infection in drug addicts has been well described in Europe, the latter agent appearing to have been introduced there in the mid-1970’s. Currently, similar data are scanty among United States addicts. We therefore reevaluated 99 drug addicts from three different geographic locations in the United States who had participated in a Veterans Administration Cooperative Study between 1972 and 1975. Almost all were asymptomatic, and all had been subjected to liver biopsy because of prolonged aminotransferase abnormalities. Stored sera were tested for antibody to hepatitis delta antigen (anti-HD) by radioimmunoassay and available liver biopsies examined for hepatitis delta antigen (HDAg) by immunofluorescence. Overall, 19.2% were HBsAg positive, 9.1% HBeAg positive, 90% anti-HBc positive and 10.170, positive for anti-HD. Anti-HD was identified,in 42.1% of addicts who were HBsAg positive and in zy 3.3% who were anti-HBs positive. No correlation was found between HBeAg and anti-HD, but anti-HD was present significantly more frequently in those with chronic active hepatitis than in those with chronic persistent hepatitis. We conclude that hepatitis delta virus infection is common in HBsAg-positive drug addicts in the United States dating back to at least 1972 and probably earlier. The hepatitis delta antigen (HDAg) is a hepatotropic human pathogen that requires hepatitis B virus (HBV) for its replication (1). It can be identified in serum as a 36 nm particle (2,3) with an outer coat of HBsAg derived from the host HBV infection, and an inner component composed of HDAg (2). Associated with this particle is a small, single-stranded RNA (1.75 kb), considered to be the genome of the pathogen (2). Because of its depend- ence on HBV, HDAg infects only those individuals who are HBsAg positive (1, 4, 5; Gerin, J L. et al., Fed. Prac. 1982; 41:445, Abstract). Hepatitis delta virus (HDV) infection may, therefore, occur concomitant with an acute bout of hepatitis B or during the course of the chronic HBsAg carrier state. In the latter instance, HDV Received April 12, 1984; accepted .July 13, 1984. Address reprint requests to: Leonard B. Seeff, M.D., Veterans Ad- ministration Medical Center, 50 Irving St., N.W., Washington, D.C. 20422. superinfection commonly induces overt and sometimes severe hepatic disease (6, 7). Epidemiologic surveys have revealed the existence of HDV in most countries of the world, although it is found surprisingly infrequently in the Far East where hepatitis B is endemic (1, 8). In the United States as in other areas where the HBsAg carrier state is relatively low, HDV infection has been identified most commonly in two groups regularly exposed to blood, namely HBsAg- positive hemophiliacs and parenteral narcotic drug abu- sers (9-11). Because reports of HDV infection in United States drug addicts are sparse at present (10, 12), we elected to reevaluate a large group of drug abusers from three different locations who had participated in a Vet- erans Administration Cooperative Study. The results confirm that HDV superinfection in United States drug addicts is common, and that it dates back to at least 1972. 1111