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Treatment and prevention of hepatitis D virus infection

Francesco Negro, MD
Anna SF Lok, MD
Section Editor
Rafael Esteban, MD
Deputy Editor
Jennifer Mitty, MD, MPH


The clinical manifestations of hepatitis D virus (HDV) infection vary from benign acute hepatitis to fulminant hepatitis and from an asymptomatic carrier state to rapidly progressive chronic liver disease. HDV is a defective virus requiring the simultaneous presence of hepatitis B virus (HBV) to fully express its pathogenicity; thus, hepatitis D always occurs in the presence of HBV. (See "Pathogenesis, epidemiology, natural history, and clinical manifestations of hepatitis D virus infection".)

In most cases of HDV infection, HBV replication is suppressed to low levels by HDV [1,2]. Liver damage in these patients is essentially due to HDV only. Occasionally, HBV and HDV replicate simultaneously, each virus contributing to the liver damage, thereby resulting in more severe liver disease [3].


The clinical course is influenced by several factors, including the HDV genotype [4]. This issue is discussed in detail elsewhere but a brief review is warranted to provide the rationale for antiviral therapy. (See "Pathogenesis, epidemiology, natural history, and clinical manifestations of hepatitis D virus infection".)

The predominant genotype in the Western world is genotype I. Once chronic HDV infection is established, it usually exacerbates the preexisting liver disease due to HBV. Progression towards cirrhosis may be rapid, but does not occur in all patients. HDV-associated chronic liver disease may run an indolent course and asymptomatic HDV carriers have been found in some geographical areas.

Patients who are currently referred for HDV infection appear to represent cohorts infected many years ago in whom the HDV-related disease rapidly developed to cirrhosis, but whose subsequent disease progression has been slow. This was illustrated in a report from Italy in which the estimated 5- and 10-year probability of survival free of liver transplantation in patients who had already developed clinically overt cirrhosis was 49 and 40 percent, respectively [5]. A more ominous course toward liver decompensation has been documented in patients with active HBV and HDV replication [5]. In the Far East, where the predominant genotype is genotype II, there is a less frequent association of chronic HDV infection with progressive liver disease [4].

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Literature review current through: Nov 2017. | This topic last updated: Apr 29, 2016.
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