Chronic delta infection and liver biopsy changes in chronic active hepatitis B.

The delta agent consists of particles of RNA nucleoprotein and is probably a defective virus present only in the livers of patients with B-viral acute or chronic liver disease. Its frequency is significantly greater in patients with chronic active hepatitis B than in those with persistent viral hepatitis B, suggesting that chronic delta infection may increase the severity of liver disease. We studied biopsy or autopsy tissue samples from 57 patients with chronic active hepatitis B for morphologic differences between chronic delta-positive and delta-negative cases. The delta-positive cases had significantly greater portal and parenchymal inflammatory change, parenchymal necrosis, and nuclear dysplastic and polyploid change than did the delta-negative cases. These findings suggest that chronic delta infection, with ongoing delta replication, may increase the degree of hepatic damage, and possibly hasten the progression of liver disease, in patients with chronic active hepatitis B.