Hepatitis B virus and hepatitis D virus co-infection complicated by autoimmune hepatitis: Two case reports

Table 1 Laboratory tests, cirrhosis status and treatment for case 1

Test item	August 2023	November 2023
Current antiviral medication	Tenofovir propofol fumarate	Tenofovir propofol fumarate
Cirrhosis stage	Decompensated	Decompensated
ALT (U/L)	985.00	17.20
AST (U/L)	2115.0	23.50
GGT (U/L)	161.61	28.93
ALP(U/L)	198.83	57.50
Alb (g/L)	27.38	41.10
TBIL (μmol/L)	97.20	45.90
DBIL (μmol/L)	60.22	23.60
IBIL(μmol/L)	36.98	22.30
LDH (U/L)	653.11	267.88
CHE (U/L)	2240	1310.00
TBA (μmol/L)	126.40	176.20
TP (g/L)	80.56	61.80
Glb (g/L)	53.18	20.70
PT (seconds)	26.80	22.20
PTA (%)	27.70	40.50
INR	2.29	1.73
WBC (109/L)	1.55	1.57
HGB (g/L)	105.00	73.00
PLT (109/L)	103.00	60.00
IgG (g/L)	47.10	13.62
AFP (ng/mL)	16.80	3.84
HBsAg (IU/mL)	12286.00	14214.00
HBeAg (IU/mL)	0.12	0.13
HBV DNA (IU/mL)	1.12 × 102	< 20
Anti-HDV IgM	Positive	Positive
Anti-HDV IgG	Positive	Positive
Liver stiffness (kPa)	16.5	17.6
Fat attenuation (db/m)	268	246
Non-alcoholic fatty liver disease	Present	Present

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transferase; ALP: Alkaline phosphatase; Alb: Albumin; TBIL: Total bilirubin; DBIL: Direct bilirubin; IBIL: Indirect bilirubin; LDH: Lactate dehydrogenase; CHE: Cholinesterase; TBA: Total bile acid; TP: Total protein; Glb: Globulin; PT: Prothrombin time; PTA: Prothrombin time activity; INR: International normalized ratio; WBC: White blood cell; HGB: Hemoglobin; PLT: Platelet; IgG: Immunoglobulin G; AFP: Alpha-fetoprotein; HBsAg: Hepatitis B surface antigen; HBeAg: Hepatitis B e antigen; HBV: Hepatitis B virus; HDV: Hepatitis D virus; IgM: Immunoglobulin M.

Table 2 Laboratory and pathological results related to autoimmune hepatitis

Test/feature		Case 1	Case 2
Anti-nuclear antibody		1:320	1:320
IgG (g/L) elevation		47.10	22.60
Liver kidney microsomal type 1 antibody		-	+
Anti-soluble liver antigen antibody		-	-
Pathology	Portal inflammation	Moderate	Moderate
	Interface hepatitis	Mild to moderate	Moderate
	Plasma cell infiltration	Present	Present
	Rosette formation	Absent	Absent
	Piecemeal necrosis	Absent	Absent
Inflammation grade (G)		G3	G2
Fibrosis stage (S)		S4	S3

IgG: Immunoglobulin G.

Table 3 Laboratory tests, cirrhosis status and treatment for case 2

Test item	June 2023	January 2024
Current antiviral medication	Entecavir	Entecavir
Cirrhosis stage	Compensated	Compensated
ALT (U/L)	77.20	47.60
AST (U/L)	60.80	32.90
GGT (U/L)	93.58	86.89
ALP (U/L)	142.50	100.40
Alb (g/L)	40.90	36.40
TBIL (μmol/L)	13.20	7.20
DBIL (μmol/L)	2.90	1.80
IBIL (μmol/L)	10.30	5.40
LDH (U/L)	218.10	214.00
CHE (U/L)	7380	6470.00
TBA (μmol/L)	5.60	21.10
TP (g/L)	78.80	67.90
Glb (g/L)	37.90	31.50
PT (seconds)	13.20	13.50
PTA (%)	83.30	95.0
WBC (109/L)	4.70	6.53
HGB (g/L)	144.00	134.00
PLT (109/L)	143.00	129.00
IgG (g/L)	22.60	14.22
AFP (ng/mL)	10.07	7.40
HBsAg (IU/mL)	7755	9605.00
HBeAg (IU/mL)	0.09	0.12
HBV DNA (IU/mL)	< 20	< 20
Anti-HDV IgM	Positive	Positive
Anti-HDV IgG	Positive	Positive
Liver stiffness (kPa)	21.6	22.7
Fat attenuation (db/m)	294	283
Non-alcoholic fatty liver disease	Present	Present

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transferase; ALP: Alkaline phosphatase; Alb: Albumin; TBIL: Total bilirubin; DBIL: Direct bilirubin; IBIL: Indirect bilirubin; LDH: Lactate dehydrogenase; CHE: Cholinesterase; TBA: Total bile acid; TP: Total protein; Glb: Globulin; PT: Prothrombin time; PTA: Prothrombin time activity; WBC: White blood cell; HGB: Hemoglobin; PLT: Platelet; IgG: Immunoglobulin G; AFP: Alpha-fetoprotein; HBsAg: Hepatitis B surface antigen; HBeAg: Hepatitis B e antigen; HBV: Hepatitis B virus; HDV: Hepatitis D virus; IgM: Immunoglobulin M.