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Living with hepatitis D

?What are the scientific advances in the field of Hepatitis D?

The hepatitis D virus (HDV) can cause acute, fulminant or chronic hepatitis.

The treatment of acute hepatitis D is based on treating the symptoms. Patients suffering from fulminant (or subacute) viral hepatitis D or terminal liver failure should be referred to a specialist unit to discuss the possibility of liver transplantation.

The aim when treating chronic hepatitis D is to block viral multiplication and bring the viral load down to an undetectable level. In the absence of viral multiplication, liver function enzyme (AST and ALT) levels drop back down to normal, the necrotic and inflammatory liver damage heals and the hepatic fibrosis regresses (1). Since HDV infection is necessarily associated with infection with the hepatitis B virus (HBV), it is always essential to address both infections and therefore attack the HBV at the same time.

Treatment Options

A recent entry-inhibitor for the treatment of chronic hepatitis D in adult patients with compensated liver disease has shown promising results (4).

Moreover, an antiviral agent belonging to the interferon family is recommended in chronic hepatitis D, although its mechanism of action is not understood and its effectiveness is limited (2).

A number of compounds are currently in clinical development.

Scientific progress

Several therapeutic alternatives for the treatment of HDV infection are in development (2).

A. Antiviral, blocks receptors on liver cells used for entry: by binding to NTCP, a specific membrane receptor expressed on liver cells, this compound blocks the intracellular penetration of HDV (3, 4).

B. Antiviral, inhibits the secretion of HBV surface antigen: its mechanism of action is poorly understood but it seems to inhibit the release of HBV surface antigen from liver cells (3).

C. Antiviral, inhibits assembly: by inhibiting interaction between HBV and HDV, this compound could block the production of HDV (3,5).

HDV replication cycle and therapeutic targets
HDV replication cycle and therapeutic targets

Sources

  1. Pascarella S, Negro F. Hepatitis D virus: an update. Liver Int. 2011; 31 (1): 7-21.
  2. https://clinicaltrials.gov/ct2/results?cond=Hepatitis+D&term=&cntry=&state=&city=&dist=
  3. Mentha N et al. A review on hepatitis D: From virology to new therapies. J Adv Res. 2019; 17: 3-15.
  4. https://ec.europa.eu/health/documents/community-register/html/h1446.htm (accessed on September 17, 2020)
  5. Koh C et al. Pathogenesis of and New Therapies for Hepatitis D. Gastroenterology 2019; 156 (2): 461 - 476.e1.