Hepatitis Delta: Epidemiology, Diagnosis and Management 36 Years After Discovery

Abstract

With recent studies showing increased prevalence of hepatitis delta (HDV) even in the US, Australia, and some countries in Europe, and very high prevalence in endemic regions, HDV infection is far from being a disappearing disease. Although immigrants from endemic countries have been shown to have increased risk, studies have clearly shown that the disease is not solely appearing in traditional high-risk groups. Recent studies provide increasing evidence that sexual transmission may be an important factor in HDV infection spread. Based on the totality of evidence showing increased disease progression and substantially increased risk of cirrhosis in HDV-infected CHB patients, and the current studies showing higher than expected prevalence, it is time to call for HDV screening of all CHB patients. HDV viral load detection and measurement should be considered in all patients whether or not they are anti-HDV-positive. With universal screening of CHB patients for HDV, earlier diagnosis and consideration of treatment would be possible. Current treatment of HDV is IFN-based therapy with or without HBV antivirals, but current research indicates the possibility that prenylation inhibitors, entry inhibitors, HBsAg release inhibitors, or other therapies currently in the pipeline may provide more effective therapy in the future. In addition, universal screening would serve the important public health goal of allowing patients to be educated on their status and on the need for HDV-negative patients to protect themselves against superinfection and for HDV-infected patients to protect against transmission to others. Further studies and global awareness of HDV infection are needed.

Hepatitis delta virus: From biological and medical aspects to current and investigational therapeutic options

“…Given the high prevalence of HDV infection in some parts of the world and the absence of decrease in Europe and North America, there is an increasing consensus to suggest that all HBV infected patients (including inactive carriers) should be screened, at least at the diagnostic of CHB, for HDV infection (151,152). This is already argued in European HBV treatment guidelines (EASL), but not in the North American counterpart; indeed AASLD's recommendations still restrict HDV screening to HBV infected patients originating from endemic countries or with a history of IV drug use (153,154).…”

Performance Characteristics of a New Consensus Commercial Kit for Hepatitis D Virus RNA Viral Load Quantification

“…HDV is responsible for much more severe liver disease, with more frequent occurrence of fulminant hepatitis and more rapid evolution to cirrhosis and hepatocellular carcinoma (HCC) in HBV/HDV-infected patients (1)(2)(3)(4)(5). The diagnosis of HDV infection relies upon the detection of total anti-HDV antibodies.…”

Hepatitis Delta Virus: Epidemiology, Natural Course and Treatment

“…Another HDV specific pathogenesis mechanisms including the big delta protein for activation of transcriptional factors (STAT3, NF-KB) and the oxidative stress pathway through NADPH oxidase have been suggested to be part of the rapid evolution of the liver disease [27]. Nevertheless, we cannot exclude that confounding factors, such as duration of infection, might explain these differences; as it has been suggested by some histological findings the absence of difference of severity between HBV or HVB/HDV carriers [28][29][30][31] and occurrence of hepatocellular carcinoma is the same (3 to 5%/year) than in B or C viral cirrhosis.…”