A prospective age/sex matched control and follow-up study was conducted to explore the reason(s) for the association of hepatitis delta virus (HDV)
infection with
hepatitis B e antigen (
HBeAg) negative
hepatitis B surface antigen (
HBsAg) carrier state. Over a 3-year period, a total of 110 patients (104 males and six females) with acute HDV
superinfection were documented in our unit. Twenty-four (21.8%) of them were
HBeAg positive at the onset of acute HDV
infection. In the control study, 110 age- and sex-matched asymptomatic
HBsAg carriers with normal serum
transaminase, as well as 110 age- and sex-matched patients with chronic type B
hepatitis were randomly selected from the computer files of the same 3-year period of entry. The prevalence of serum
HBeAg in patients with HDV
infection was similar to that of asymptomatic
HBsAg carriers (20.9%), but significantly lower than that of the patients with chronic type B
hepatitis (72.7%). In a follow-up study of 16
HBeAg-positive patients with HDV
infection, eight (50%) cleared
HBeAg and three (18.8%) seroconverted to anti-HBe within 3 months. The
HBeAg clearance rate was significantly higher than for chronic type B
hepatitis and asymptomatic carriers (p less than 0.01). The results suggest that the low prevalence of serum
HBeAg in HDV
infection simply reflects the
HBeAg/anti-HBe status of the asymptomatic
HBsAg carriers in the population under study. Also in some patients HDV
superinfection may itself suppress HBV and thus clear
HBeAg.