Hepatitis Delta Virus: Epidemiology, Natural Course and Treatment

The hepatitis delta virus (HDV) is a defective hepatotropic virus that affects only patients with hepatitis B virus (HBV) infection. These 2 viruses share the same routes of transmission (parenteral, sexual, and mother to child). The hepatitis delta virus infection may result in acute hepatitis, including fulminant presentation or spontaneously resolving infection, and chronic infection. The prognosis depends on the chronology of the 2 infections, co-infection (higher risk of fulminant hepatitis) or super-infection (frequent evolution to chronicity). The harmfull impact of HIVassociated infection is today debated even if HDV antibodies are present in 12% and 4% of HIV/HBV co-infected and HBV-mono-infected patients respectively. HDV may be treated by interferon, the unique treatment, but relapse is observed in 50% of cases after discontinuation of therapy: only 25% of treated patients achieved a sustained virologic response. Entry HBV/HDV inhibitors (Myrcludex) and prenylation inhibitors are awaited encouraging progress in treating HDV infection. The treatment is recommended in patients with significant fibrosis; viral suppression may result in fibrosis stabilization or reversal which may be also observed in the absence of complete viral eradication. The prevention of hepatitis delta virus infection is based on hepatitis B virus vaccination