Overview
Acute hepatitis B with hepatitis D (HDV) coinfection is a severe form of viral hepatitis. HDV coinfection can lead to more rapid progression of liver disease, higher rates of cirrhosis, and increased risk of hepatocellular carcinoma compared to hepatitis B virus (HBV) infection alone.Diagnosis
Diagnosis is confirmed by serological testing for both HBV and HDV.
Tests include hepatitis B surface antigen (HBsAg), hepatitis B e-antigen (HBeAg), anti-HBc IgM, and anti-HDV IgM and IgG antibodies 1.Management
Treatment for severe acute exacerbation of chronic hepatitis B (CHB) with tenofovir disoproxil fumarate (TDF) or lamivudine (LAM) followed by TDF has been studied.
In a study comparing TDF versus LAM followed by TDF for 24 weeks in patients with CHB and severe acute exacerbation, the primary endpoint was overall mortality or receipt of liver transplantation by week 24. Seven of 19 patients (37%) in the TDF group and five of 18 patients (28%) in the LAM-TDF group met this endpoint 1.Key Recommendations
Tenofovir disoproxil fumarate (TDF) or lamivudine (LAM) followed by TDF may be considered for the management of severe acute exacerbation of chronic hepatitis B (CHB) 1. (Evidence: Moderate)References
1 Lu CM, Cheng JS, Sun WC, Chen WC, Tsay FW, Wang HM et al.. Randomized Controlled Study of Tenofovir versus Lamivudine Followed by Tenofovir in Severe Exacerbation of Hepatitis B. Antimicrobial agents and chemotherapy 2022. link