[Update hepatitis D].

Area of Science:

• Hepatology
• Virology
• Infectious Diseases

Background:

• Chronic hepatitis D infection is a significant global health concern due to its high morbidity.
• Prevalence patterns are shifting, with decreases in the Mediterranean Basin and increases in Eastern Europe.
• Hepatitis D virus (HDV) is a unique pathogen requiring hepatitis B surface antigen (HBsAg) for replication.

Purpose of the Study:

• To highlight the clinical relevance and epidemiological trends of chronic hepatitis D.
• To emphasize the importance of screening for HDV antibodies in HBsAg-positive individuals.
• To discuss the challenges in differentiating HDV/HBV co-infection from superinfection and current treatment strategies.

Main Methods:

• Review of epidemiological data on hepatitis D prevalence.
• Discussion of HDV virology and its dependence on HBsAg.
• Analysis of diagnostic differentiation between HDV/HBV co-infection and superinfection.
• Overview of current and potential therapeutic interventions for chronic hepatitis D.

Main Results:

• Hepatitis D prevalence is declining in traditional areas but rising in Eastern Europe, posing challenges for immigrant populations in regions like Germany.
• HDV requires HBsAg for propagation, necessitating screening for HDV antibodies upon HBsAg detection.
• Distinguishing between simultaneous HDV/HBV infection (often clearing spontaneously) and HDV superinfection (frequently chronic) is critical.

Conclusions:

• Chronic hepatitis D is challenging to treat, with interferon-based therapies being the current standard.
• New therapeutic avenues, including pegylated interferons, extended treatment durations, combination therapies, and prenylation inhibitors, are being explored.
• Effective management requires accurate diagnosis, differentiation of infection types, and consideration of emerging treatment options.