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Hepatitis D, B and C virus (HDV/HBV/HCV) coinfection as a diagnostic problem and therapeutic challenge
Beata Lorenc1, Katarzyna Sikorska1,2, Piotr Stalke3
1Pomeranian Center of Infectious Diseases, Gdansk, Poland.
Insights
Hepatitis D virus (HDV) coinfection accelerates liver cirrhosis in chronic hepatitis B patients. Treatment efficacy for HDV is limited, necessitating consideration in complex viral hepatitis cases.
Area of Science:
- Hepatology
- Virology
- Gastroenterology
Background:
- Hepatitis D virus (HDV) coinfection significantly worsens outcomes in chronic hepatitis B virus (HBV) infection, leading to accelerated liver cirrhosis.
- Understanding the clinical course and treatment response in patients with concurrent HBV, hepatitis C virus (HCV), and HDV infections is crucial.
Observation:
- Two male patients with established HBV and HCV infections presented with HBsAg-positive and anti-HCV-positive status.
- Despite antiviral therapies including interferon, lamivudine, and pegylated interferon, one patient showed progression of liver fibrosis to F4 stage (cirrhosis).
Findings:
- Coinfection with HDV, HBV, and HCV presents complex clinical scenarios.
- The efficacy of standard antiviral treatments, including interferon-based therapies, appears severely limited for HDV infection.
- Ultrasound elastography indicated disease progression even with virological responses to anti-HBV treatments.
Implications:
- HDV infection should be suspected in patients with chronic HBV, particularly those exhibiting minimal HBV replication, elevated aminotransferases, and disease progression despite therapy.
- Further research into effective therapeutic strategies for HDV coinfection is warranted.
- Early consideration of HDV is vital for accurate diagnosis and management of advanced liver disease.
Abstract:
Coinfection with hepatitis D virus (HDV) in chronic hepatitis B is associated with more rapid progression to liver cirrhosis. We present two cases of infection with hepatitis D, B and C viruses. Both male patients were primarily diagnosed as infected with hepatitis B virus (HBV) and hepatitis C virus (HCV), HBsAg-positive and anti-HCV-positive. The first patient was treated with interferon, lamivudine and pegylated interferon. A full virological and biochemical response was achieved. The second patient was treated with interferon and ribavirin, lamivudine and twice with pegylated interferon. In the ultrasound elastography progression of liver fibrosis to F4 was described. HDV infection should be considered in patients with HBV minireplication, high activity of aminotransferases and progression of liver disease despite a good virological response to anti-HBV treatment. Efficacy of interferon in HDV infection is severely limited.
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