Overview
Chronic hepatitis D (CHD) is a severe form of viral hepatitis caused by co-infection with hepatitis B virus (HBV) and hepatitis D virus (HDV) 1. It is associated with a higher risk of liver disease progression, including cirrhosis and hepatocellular carcinoma, compared to chronic hepatitis B alone 4.Diagnosis
Hepatitis D virus (HDV) RNA levels are used to assess treatment response 1.
Hepatitis B surface antigen (HBsAg) and anti-HDV antibody testing are used for diagnosis 2.
In Canada, foreign-born individuals represent a significant proportion of adults with chronic hepatitis B and HDV 2.Management
Pegylated interferon alfa-2a is recommended as an off-label treatment for chronic hepatitis D 1.
Bulevirtide in combination with pegylated interferon alfa-2a is being investigated for finite treatment 1.
Nucleoside/nucleotide analogues with a high barrier to resistance are first-line therapies for chronic hepatitis B 4.
Tenofovir disoproxil fumarate (TDF) and entecavir (ETV) are recommended first-line treatments for chronic hepatitis B, with TDF associated with greater reductions in estimated glomerular filtration rate and serum phosphorus levels compared to ETV 3.Key Recommendations
Bulevirtide at a daily dose of 10 mg in combination with peginterferon alfa-2a for 48 weeks, followed by bulevirtide monotherapy for 48 weeks, resulted in undetectable HDV RNA in 46% of patients 24 weeks after treatment cessation 1. (Evidence: Moderate)
Nucleoside/nucleotide analogues with a high barrier to resistance are the first-line therapies for chronic hepatitis B 4. (Evidence: Expert opinion)
Semi-annual liver ultrasound and serum alpha-fetoprotein testing should be performed in all patients with chronic HBV infection for early detection of hepatocellular carcinoma 4. (Evidence: Expert opinion)References
1 Asselah T, Chulanov V, Lampertico P, Wedemeyer H, Streinu-Cercel A, Pântea V et al.. Bulevirtide Combined with Pegylated Interferon for Chronic Hepatitis D. The New England journal of medicine 2024. link
2 Wong RJ, Hirode G, Feld J, Wong SS, Brosgart C, Glenn J et al.. An updated assessment of hepatitis delta prevalence among adults in Canada: A meta-analysis. Journal of viral hepatitis 2024. link
3 Yang X, Yan H, Zhang X, Qin X, Guo P. Comparison of renal safety and bone mineral density of tenofovir and entecavir in patients with chronic hepatitis B: a systematic review and meta-analysis. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 2022. link
4 Higuera-de-la-Tijera F, Castro-Narro GE, Velarde-Ruiz Velasco JA, Cerda-Reyes E, Moreno-Alcántar R, Aiza-Haddad I et al.. Asociación Mexicana de Hepatología A.C. Clinical guideline on hepatitis B. Revista de gastroenterologia de Mexico (English) 2021. link