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Hepatitis D virus (HDV) has decreased in Europe, but recent reports indicate a rising trend. We report the epidemiological changes, clinical progress, and effect of treatment on the natural course of HDV infection in Greece during the last 13 years.Prospective data were extracted from the HepNet.Greece Cohort-Study.Since 1997, 4673 chronic HBV (CHB) cases (4527 adults, 146 children) have been followed prospectively. Two thousand one hundred thirty-seven patients were tested for anti-HDV [101 (4.7%) positive]. Anti-HDV testing in Greece decreased significantly (57.0% before 2003, 35.3% thereafter; p0.001). Anti-HDV prevalence among HBsAg-positives was 4.2%; lower in native Greeks (2.8%) than in immigrants (7.5%) or in children (15.3%; p0.001). Within 2.3 years of follow-up, HDV occurred in 11/2047 HBsAg-positive patients (2.2 new delta-infected adults and 8.7 children per 1000 HBsAg-positive annually). HDV-positive compared to CHB adults were younger (p=0.035) and had more active and advanced disease at baseline, as indicated by laboratory indices and the higher prevalence of cirrhosis at younger age. During a 4.2-year median observation, significantly more anti-HDV-positive than CHB adults developed a liver-related first event (20.0% vs. 8.5%, p Log-rank=0.014).Treatment was received by 46/90 (51.1%) patients, 40 of them interferon-based. In multivariable analysis, interferon significantly decreased disease progression in HDV-positive patients [HR=0.14 (95% CI: 0.02-0.86; p=0.033)].In Greece, HDV serology is currently tested in only one-third of HBsAg-positive patients. HDV prevalence is lower in native Greeks compared to immigrants, who may contribute50% of the HDV infection burden in Greece. Data show that HDV infection is a rapidly progressive disease, but interferon-based treatment may alter its course.

To evaluate the clinicopathological features of chronic hepatitis C, 170 liver biopsies were studied and histological grade and stage (degree of fibrosis) of hepatitis were correlated with epidemiological features and characteristic histological findings.Normal liver was found in 3 (1.8%), minimal chronic hepatitis in 40 (23.5%), mild chronic hepatitis in 104 (61.2%) and moderate chronic hepatitis in 23 (13.5%) cases. Cirrhosis was observed in 24 (14.1%) patients and was more frequently encountered among patients more than 40 years old (34.4% vs 2.8%, p10(-6) and rarely among intravenous drug users in comparison with post-transfusion and sporadic cases (3% vs 25% and 20% respectively, p0.005). Minimal chronic hepatitis was more frequently observed among patients 40 years old or younger (30.3% vs 11.5%, p0.01)), while moderate chronic hepatitis was significantly more common in older age groups (24.6% vs 7.3%, p0.005). Multiple regression analysis revealed that only age was statistically related to histological grade and stage of hepatitis (p10(-5). The frequency of the histological features more likely seen in chronic hepatitis C, including steatosis (57.6%), lymphoid follicles and/or aggregates (F/A) (47.1%) and bile duct lesions (22.9%), increased with hepatitis grade and the latter two features were more often encountered in moderate chronic hepatitis (p0.005); in addition, both lesions statistically coexisted (p0.005). No correlation was found between histological findings and possible source of infection.More than half of the chronic hepatitis C patients presented mild histological lesions. Age was proven to be the only independent epidemiological factor related to histological grade and stage of hepatitis. Lymphoid F/A and bile duct damage are important diagnostic findings associated with hepatitis activity.