Hepatitis D virus antibody in HBsAg‐positive and HBsAg‐negative substance abusers with chronic liver disease

The hepatitis D virus (HDV; previously called the “delta agent”) is a defective organism which can replicate only in the presence of the hepatitis B virus (HBV). We tested the serum of 95 substance abusers, all of whom had sufficient evidence of chronic liver disease to warrant a liver biopsy, for hepatitis D virus antibody (anti‐HDV). Anti‐HDV was detected in five of eight hepatitis B surface antigen (HBsAg)‐positive patients and 12 of 87 (14%) HBsAg‐negative patients. Antibody to the hepatitis B core antigen (anti‐HBc) was the sole hepatitis B marker in eight of the 12 (67%) anti‐HDV‐positive, HBsAg‐negative patients but in only 14 of 75 (19%) anti‐HDV‐negative, HBsAg‐negative patients (P < 0.005). None of the anti‐HDV‐positive, HBsAg‐negative patients had detectable IgM anti‐HBc in the serum or hepatitis D antigen in liver tissue, and they had similar clinical features and liver biopsy diagnoses to HBsAg‐negative patients without anti‐HDV. We conclude that anti‐HDV in HBsAg‐negative substance abusers reflects infection with HDV and HBV in the distant past and does not indicate more severe liver disease than that seen in HBsAg‐negative patients without anti‐HDV.