I've recently heard of a case of fulminant hepatitis with hep D and E. The person who told me about the case insists that hepB was negative and I have a hard time believing this scenario. Is it possible for hepE to provide the same replicative support that hepB does for hepD?
Dear Cosmina,
Coming just back from Human Viral Hepatitis congress in Germany, I can tell you Yes, delta hepatitis is a distinct virus that is dependent upon hepatitis B infection. This form of hepatitis may occur as a super-infection in a hepatitis B carrier or as a co-infection. The above is much less clear-cut for hepE.
Best wishes,
Ilya
Dear Cosima,
The socalled hepatitis D virus is a transmissable, defective, non-enveloped virus-like particle/RNA. To be able to spread, it needs the help of HBV, namely its envelope.
As HEV is non-enveloped as well, it cannot provide an envelope for HDV to spread, and thus should be unable to compensate HDV's natural defect.
With best regards,
Sabine
AS with the other responses, HDV infection and replication are not possible if HBV is not present in hepatocytes. It is possible that if HDV / HEV were actually detected in your colleague's patient, that HBV might not be detected in blood, if only serologic or low sensitivity HBV DNA assays were used, or perhaps PCR primers for a HBV wild type genome were used when the HBV present was a mutant strain relative to the primers.
It is pretty common for any viral fulminant hepatitis to suppress the expression of other viruses present and therefore depress detectability in general. This is true with all of the hepatotrophic viruses (A thru GB). The way for your colleague to attempt to prove this (which we would all doubt or refute anyway ;-), is that they would need to obtain liver tissue, and do molecular and immunohistochemical testing to get anyone to remotely believe an HDV infection without HBV, regardless of any other viruses present in the tissue.
Thank you so much for your detailed answers. I didn't consider this idea that an aggressive virus could suppress the expression of other viruses and therefore decrease detectability. The patient is deceased. I'm looking forward to getting more data from the transplant center (the patient had hepatic carcinoma and was on the transplant list--, which again pleads for a chronic HepB infection).
For HDV , it is a defective virus that needs HBV for visbility and hence infectivity, thus infection with this virus is either a coinfection with or a superinfection on top of HBV.This doesnt apply for HEV, and HEV perse can cause fulminant hepatitis specially in pregnancy or organ transplantation. Searching for an explanation for HDV in absence of HBV, there could be one of 2 scenarios , either an occult form of the disease where even HBV-DNA could be below the detectible level, or an X mutant that may hinder HBV-DNA detection serologically. Thus, i think that HBcAb total may give a clue in this case about HBV status, adfitionally i would recommend repeating HBV-DNA with a sensitive test of a 15 copies/ml detection cut-off
we need to look for occult HBV as well as the serological pattern of the patients since some HBV-Anti-core positive patient support HDV replication
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