Overview
Hepatitis D virus (HDV) is a defective virus that requires the presence of hepatitis B virus (HBV) to complete its life cycle and cause human liver disease 1. It is considered the most aggressive form of viral hepatitis, frequently leading to rapid progression to cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC) 12. Chronic HDV infection represents a more severe form of liver disease compared to HBV mono-infection 3.Diagnosis
Screening: Testing is indicated for HBsAg-positive individuals to identify HDV co-infection or superinfection 2.
Virologic Testing: Diagnosis and characterization require the identification of HDV-RNA to confirm persistent infection 13.
Clinical Assessment: Evaluation should include clinical characterization and prognostic assessment for liver damage 1.
Staging: Patients must be assessed for the presence of cirrhosis and end-stage complications due to the high risk of rapid disease progression 1.Management
First-line Therapy: Pegylated interferon (peginterferon) alpha-2a or -2b is the primary treatment regimen 3.
Treatment Duration: Peginterferon should be administered for at least 48 weeks 3.
Comparative Efficacy: Peginterferon is superior to standard interferon, whether used alone or in combination with nucleos(t)ide analogues 3.
Treatment Goals: The primary efficacy endpoint is virological response (VR), defined as HDV-RNA negativity 24 weeks after completing therapy 3.
Response Rates: Pooled virological response at 24 weeks post-treatment is approximately 29%, while biochemical response (ALT normalization) is achieved in 33% of patients 3.
HBsAg Clearance: Seroconversion to anti-HBs is a secondary goal, though it is achieved in a minority of cases 3.Special Populations
Inactive HBV Carriers: HDV prevalence may remain stable in this population even when regional trends in chronic hepatitis patients fluctuate 2.
HBV-Infected Individuals: Prevalence patterns vary by geographic region and are influenced by the implementation of routine HBV vaccination programs 2.Key Recommendations
Use pegylated interferon (alpha-2a or -2b) for a minimum of 48 weeks as the preferred treatment for chronic HDV infection 3. (Evidence: Strong)
Prioritize peginterferon over standard interferon or nucleos(t)ide analogue monotherapy due to higher rates of virological and biochemical response 3. (Evidence: Strong)
Perform comprehensive clinical and virologic characterization of all HDV-infected individuals to assess the risk of progression to cirrhosis and HCC 1. (Evidence: Expert opinion)
Define treatment success as the absence of HDV-RNA 24 weeks after the cessation of peginterferon therapy 3. (Evidence: Strong)
Maintain routine HBV vaccination programs as a primary measure to reduce the prevalence of HDV infection 2. (Evidence: Moderate)References
1 . EASL Clinical Practice Guidelines on hepatitis delta virus. Journal of hepatology 2023. link
2 Uraz S, Deniz Z, Zerdali EY, Araslanova A, Tahan V, Tabak F et al.. The changing epidemiology of delta hepatitis in Türkiye over three decades: A systematic review. Journal of viral hepatitis 2023. link
3 Abdrakhman A, Ashimkhanova A, Almawi WY. Effectiveness of pegylated interferon monotherapy in the treatment of chronic hepatitis D virus infection: A meta-analysis. Antiviral research 2021. link