[Hepatitis D screening is important in the Czech Republic as well]
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Published on: March 13, 2015
Petr Husa1, Svatava Snopková, Petr Husa
1Clinic of infectious diseases, The University Hospital Brno, Brno, Czech Republic,
Insights
Hepatitis D virus (HDV) infection, which requires prior hepatitis B virus (HBV) infection, rapidly progresses to severe liver disease. Current treatments lack long-term efficacy, highlighting the need for better screening and therapies.
Area of Science:
- Hepatology
- Virology
- Infectious Diseases
Background:
- Hepatitis D virus (HDV) infection exclusively affects individuals with hepatitis B virus (HBV) infection.
- HDV can be acquired as a co-infection or superinfection, primarily through contaminated needles or transfusions.
- Chronic hepatitis D represents the most severe form of viral hepatitis, accelerating the progression to decompensated cirrhosis and hepatocellular carcinoma (HCC).
Purpose of the Study:
- To highlight the clinical significance and rapid progression of chronic hepatitis D.
- To underscore the limitations of current diagnostic and therapeutic strategies for HDV infection.
- To emphasize the need for routine HDV screening in chronic HBV patients.
Main Methods:
- Review of existing literature on HDV transmission, pathogenesis, and clinical outcomes.
- Analysis of the progression rates of cirrhosis and HCC in dual HBV/HDV infections.
- Evaluation of current treatment options, including pegylated interferon alpha and emerging therapies like bulevirtide.
Main Results:
- Dual HBV/HDV infection leads to significantly faster development of liver cirrhosis (within 5 years) and HCC (within 10 years).
- HDV replication typically suppresses HBV replication, resulting in detectable HDV RNA and low/undetectable HBV DNA.
- Current treatments, such as pegylated interferon alpha, offer limited long-term efficacy.
Conclusions:
- Chronic hepatitis D is a severe condition requiring urgent clinical attention.
- The absence of routine HDV screening in regions like the Czech Republic poses a significant public health challenge.
- Emerging therapies, such as bulevirtide, show promise for managing HDV infection, warranting further investigation.
Abstract:
Only patients infected with hepatitis B virus (HBV) can contract hepatitis D virus (HDV) infection, either simultaneously (co-infection) or as a superinfection in those already infected with HBV. The routes of HDV transmission are contaminated needles or transfusion; sexual and vertical transmissions are relatively rare. Chronic hepatitis D is the most serious form of chronic viral hepatitis due to more rapid progression to decompensated cirrhosis and hepatocellular carcinoma (HCC). Liver cirrhosis may develop within five years and HCC within 10 years of dual infection. In the vast majority of cases, HDV replication suppresses HBV replication. Therefore, most patients are positive for HDV RNA in plasma while showing no or low levels of HBV DNA. At present, there is no routine screening for HDV in persons with chronic HBV infection in the Czech Republic. One of the reasons the absence of approved treatment op-tions, with the only possibility being administration of pegylated interferon alpha for 48 weeks or even longer. This approach does not provide long-term efficacy in most cases. Therapy with bulevirtide seems to be promising according to available data.
