The effect of HIV disease on serum markers of hepatitis delta infection in intravenous drug abusers
Lake-Bakaar, G.; Bhat, K.; Govindarajan, S.
Journal of Laboratory and Clinical Medicine 124(4): 564-568
1994
ISSN/ISBN: 0022-2143 PMID: 7930880 Document Number: 423762
The prevalence of serum markers of delta hepatitis was determined prospectively in 82 intravenous drug abusers at various stages of human immunodeficiency virus (HIV) disease. Seventeen were HIV negative, 30 were HIV positive without acquired immunodeficiency syndrome (AIDS) and 35 had been diagnosed as having AIDS. Antihepatitis D virus (HDV) in serum was measured by a commercially available enzyme-linked immunosorbent assay (ELISA) and also by solid phase capture radioimmunoassays (RIAs) for immunoglobulin G (IgG) and immunoglobulin M (IgM) antiHDV. HDV antigen and hepatitis B virus (HBV) DNA were also measured. Hepatitis B surface antigen (HBsAg) and anti-HBs were determined by using a commercially available RIA. Anti-HDV (RIA) was only detected in serum that contained HBsAg. These antiHDV (RIA) positive samples also tested positive with the commercial anti-HDV electroimmunoassay. In addition, the commercial anti-HDV ELISA detected anti-HDV in some serum samples that were negative for HBsAg; these anti HDV-positive HBsAg-negative samples were frequently lipemic or contained rheumatoid factor. The prevalence of HBsAg and anti-HBs did not differ significantly with the stage of HIV disease. HBsAg was detected in 3 of 13 (23%) HIV-negative, 5 of 29 (17%) HIV-positive, and 4 of 18 (22%) patients with AIDS. IgG and IgM anti-HDV (RIA) was positive in 2 of 3 HIV-negative and 4 of 5 HIV-positive pre-AIDS HBsAg-positive subjects. However, none of 4 AIDS patients had anti-HDV. The difference between AIDS and non-AIDS patients was statistically significant (Fisher's exact test, p = 0.03). HDV antigen was detected in serum from one AIDS patient. Our data suggest that a commonly used commercial ELISA for anti-HDV is frequently associated with falsely positive results in lipemic serum or serum containing rheumatoid factor and that AIDS in subjects who are intravenous drug abusers is associated with significant reduction in the incidence of IgG and IgM anti-HDV in the serum. The low prevalence of anti-HDV in AIDS probably reflects defective anti-HDV production rather than reduced HDV replication and expression.