Hepatitis delta and HIV infection

Area of Science:

• Hepatology
• Virology
• Infectious Diseases

Background:

• Viral liver diseases are common in HIV-positive individuals, contributing to mortality.
• Hepatitis C and B are manageable, but hepatitis delta virus (HDV) infection lacks effective treatments, increasing cirrhosis and liver cancer risk.
• Sexual contact is the primary HDV transmission route in Europe and North America.

Purpose of the Study:

• To review the current landscape of HDV treatment in HIV-coinfected patients.
• To highlight emerging therapeutic strategies and their potential for HDV suppression and cure.
• To discuss the implications of new cell entry receptor discoveries for HDV therapy.

Main Methods:

• Review of current literature on HDV and HIV coinfection treatments.
• Analysis of emerging therapeutic agents targeting HDV replication and cell entry.
• Discussion of treatment goals, including viral suppression and potential cure.

Main Results:

• Pegylated interferon-alfa (PegIFNα) has limited efficacy (<25% sustained clearance).
• New therapies, including sodium taurocholate cotransporting polypeptide inhibitors (e.g., Myrcludex-B), prenylation inhibitors (e.g., lonafarnib), and nucleic acid polymers, show promise.
• Sustained HDV replication suppression leads to improved liver enzymes and histology.

Conclusions:

• Emerging HDV therapies offer new hope for managing liver disease in coinfected patients.
• Co-administration with anti-HBV agents is crucial to prevent HBV rebound.
• The potential for HDV cure exists, possibly without eradicating HBV cccDNA, by achieving viral suppression and HBsAg clearance.