Hepatitis D: A Review

Area of Science:

• Hepatology and Virology
• Infectious Diseases
• Gastroenterology

Background:

• Hepatitis D virus (HDV) coinfection with hepatitis B virus (HBV) affects millions globally, leading to more severe liver disease, including cirrhosis and hepatocellular carcinoma.
• HDV superinfection in chronic HBV carriers results in rapidly progressive liver disease, with high rates of cirrhosis and mortality, although disease progression can be variable.

Approach:

• Review of HDV epidemiology, disease progression, diagnostic challenges, and current/emerging therapeutic strategies.
• Analysis of clinical trial data for novel HDV therapies, including bulevirtide and lonafarnib, assessing their efficacy and safety profiles.
• Evaluation of existing treatments like interferon alfa and the limitations of HBV nucleos(t)ide analogues against HDV.

Key Points:

• HDV infection significantly worsens liver disease outcomes compared to HBV alone.
• Accurate diagnosis of HDV remains a challenge, limiting timely intervention for many affected individuals.
• Novel therapies bulevirtide and lonafarnib demonstrate potential for virological and biochemical response in clinical trials.

Conclusions:

• HDV poses a substantial global health burden due to its aggressive nature and association with severe liver complications.
• While interferon alfa offers some benefit, its adverse effects are common, and HBV-directed therapies are ineffective against HDV.
• Emerging treatments like bulevirtide represent a significant advancement in managing chronic HDV infection, with ongoing research to optimize therapeutic strategies.