Hepatitis Delta Virus: Epidemiology, Natural Course and Treatment

Abstract

The hepatitis delta virus (HDV) is a defective hepatotropic virus that affects only patients with hepatitis B virus (HBV) infection. These 2 viruses share the same routes of transmission (parenteral, sexual, and mother to child). The hepatitis delta virus infection may result in acute hepatitis, including fulminant presentation or spontaneously resolving infection, and chronic infection. The prognosis depends on the chronology of the 2 infections, co-infection (higher risk of fulminant hepatitis) or super-infection (frequent evolution to chronicity). The harmfull impact of HIVassociated infection is today debated even if HDV antibodies are present in 12% and 4% of HIV/HBV co-infected and HBV-mono-infected patients respectively. HDV may be treated by interferon, the unique treatment, but relapse is observed in 50% of cases after discontinuation of therapy: only 25% of treated patients achieved a sustained virologic response. Entry HBV/HDV inhibitors (Myrcludex) and prenylation inhibitors are awaited encouraging progress in treating HDV infection. The treatment is recommended in patients with significant fibrosis; viral suppression may result in fibrosis stabilization or reversal which may be also observed in the absence of complete viral eradication. The prevention of hepatitis delta virus infection is based on hepatitis B virus vaccination

Sero-Prevalence and Risk Factors for HDV Infection Among HIV/HBV Co-Infected Patients in Sokoto North Western Nigeria

“…The higher prevalence of HDV infection in HIV/HBV co-infected study participants with positive history of multiple sexual partners, needle sharing and blood transfusion even though not statistically significanct, is not unexpected because HBV and HDV infections have common routes (such as sexual and parenteral) of transmission (Greenwood et al, 1997;Sultanik and Pol, 2016). In contrast, Motamedifar et al, (2015) in their study recorded significant difference with regards to blood transfusion, however did not observe significant difference with regards to intravenous drug usage and unsafe sexual contact.…”

“…This may suggest that HDV infection in our study participants may be as a result of super infection and not a co-infection, as ''HDV super-infection may lead to HBe Ag sero-conversion.'' (Sultanik and Pol, 2016).…”

“…Tropical and sub-Tropical regions have the highest prevalence of HDV infection and about 5 % of HBV infected patients may be affected by HDV infection (Sultanik and Pol, 2016). Hepatitis D Virus (HDV) infection occurs simultaneously with HBV infection or as super-infection of HBV infection (Greenwood, 1997;Sultanik and Pol, 2016). Both HBV and HDV infections may persist following HDV super-infection and the severity of HBV infection increases with HDV co-infection (Greenwood, 1997).…”

“…Fulminant hepatitis is more common in HDV/HBV co-infection than in HBV infection alone, HBV vaccine prevents HDV infection and HDV prognosis in the setting of HIV infection is open to doubt (Sultanik and Pol, 2016). Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST) are some of the tests that measure liver cell integrity.…”

“…Autoimmune manifestations, hepatocellular carcinoma and liver failure may follow as the complications of HDV infection (http: //www.emedicine.medscape.com/article/178038-overview). DOI: 10.21522/TIJPH.2013.07.01.Art001 ISSN: 2520-3134 New drugs such as prenylation and myrcludex are active against HBV and HDV and are therefore promising for the treatment of HBV/HDV co-infection (Sultanik and Pol, 2016).…”