Overview
Hepatitis D virus (HDV) is a hepatotropic virus that requires hepatitis B virus (HBV) for replication and infectivity 2. It significantly impacts global health, with varying prevalence across regions 2.Diagnosis
Management
Pegylated interferon-alfa-2a (PEG-IFNa) 180 μg weekly in combination with tenofovir disoproxil fumarate (TDF) 300 mg once daily was investigated for hepatitis D treatment 1.
Hepatitis flares, defined as ALT increases above 10 times the upper limit of normal or increases of more than 2.5-fold above baseline or nadir values, occurred in 23% of patients during treatment and 11.7% post-treatment in one study 1.
ALT flares did not differ between PEG-IFNa plus placebo and PEG-IFNa plus TDF arms 1.
ALT flares did not differ between cirrhotic and non-cirrhotic patients, and no liver decompensation occurred in cirrhotic patients during or after a flare 1.
Fifty-four percent of patients experiencing an ALT flare had a decrease in HDV RNA (>1 log10 copies/mL) 1.
Premature withdrawal from PEG-IFNa therapy due to ALT flares is not indicated 1.Special Populations
Key Recommendations
Pegylated interferon-alfa-2a therapy in patients with hepatitis D may lead to ALT flares in over one-third of cases, but these flares do not appear to pose a significant safety risk and should not prompt treatment withdrawal 1. (Evidence: Moderate)
Global prevalence of HDV varies by region, with MENA and Africa showing notable rates 2. (Evidence: Moderate)
Tailored public health strategies, including vaccination and awareness campaigns, are needed to address the diverse global prevalence patterns of hepatotropic viruses 2. (Evidence: Moderate)References
1 Hardtke S, Yurdaydin C, Caruntu FA, Curescu MG, Yalcin K, Akarca US et al.. Frequency, Severity and Impact of Pegylated Interferon Alpha-Associated Flares in Hepatitis D Infection. Journal of viral hepatitis 2025. link
2 Adeiza S, Islam M, Mungadi H, Shuaibu A, Sah R. A preregistered meta-meta-analysis on the global distribution of Hepatotropic Viruses. Voprosy virusologii 2024. link