Hepatitis D virus in individuals with HIV and hepatitis B virus: current epidemiology, treatment and prevention

This review describes the drastic changes in the epidemiology, treatment and prevention landscape of hepatitis D virus (HDV), one of the more severe forms of viral hepatitis, that have occurred over the last decade in the context of HIV and hepatitis B virus (HBV).

HBV/HDV infection appears mostly concentrated within specific groups where the HIV-epidemic is localized and more general where HIV is endemic; nevertheless, epidemiological data are lacking, especially for individuals currently in care. New treatments bearing anti-HDV activity have been or are currently being developed. Meanwhile, HBV vaccines with a novel CpG-adjuvant have produced higher rates of vaccination response.

Recent European guidance recommends that all individuals with HBV, regardless of HIV-status, undergo anti-HDV antibody testing. HDV testing must clearly be increased, which could be aided by reflex HBV/HDV testing. Individuals with active infection should be considered for treatment and close monitoring. Of all novel anti-HDV agents, only bulevirtide has been evaluated in HIV/HBV/HDV infection and extended treatment durations are possible to increase response rates. Newer vaccinations should be used for those without HBV vaccination, especially when no longer using tenofovir-containing regimens, to prevent both HBV/HDV infection.