Loss of HBsAg with interferon‐α therapy in chronic hepatitis D virus infection

Abstract

Eleven patients with chronic hepatitis D virus (HDV) infection who had chronic active hepatitis and HDV antigen on liver biopsy were randomised in a crossover therapeutic trial of interferon-alpha 2b vs. no therapy. Nine patients had a history of intravenous drug use (drug free > 6 months before therapy), 8 had histological evidence of cirrhosis, and 7 out of 10 tested were found to be seropositive for antibody to hepatitis C virus (HCV). Six patients were randomised to receive interferon-alpha 2b therapy for 1 year, and 5 patients received no therapy for 1 year followed by the same regime of interferon-alpha 2b treatment. All patients with a history of intravenous drug use found self-injection stressful, 3 patients restarted using illicit drugs, and 2 patients with active cirrhosis developed severe thrombocytopenia during therapy and treatment was stopped in these patients. Of the 6 patients who completed at least 11 months of treatment, 4 lost serum hepatitis B surface antigen (HBsAg) with 3 developing antibody to HBsAg and one patient completing treatment. Among the 6 patients who had posttreatment liver biopsy, 5 showed an improvement in liver histology (3 of them lost serum HBsAg). These results provide further evidence that interferon-alpha is beneficial in chronic HDV infection although the psychological stress associated with the treatment, especially in patients with a previous history of intravenous drug use, is not inconceivable.

Pegylated interferon alpha-2b as monotherapy or in combination with ribavirin in chronic hepatitis delta

“…15 Consistent with the superior results achieved in therapy of chronic HBV and HCV diseases using pegylated rather than standard IFN, the results of our study would also support the use of PEG-IFN as a first-line therapy and the recommendation to initiate therapy as early as possible for those with chronic hepatitis D. In fact, the efficacy of standard IFN-␣ in the treatment of chronic delta hepatitis (CHD) remains controversial; the few controlled and the many small uncontrolled trials of the use of standard IFN as a treatment for CHD found that HDV synthesis was suppressed in a fraction of patients while on therapy, but treatment failed to induce sustained clearance of the virus post-therapy; transient and occasionally even permanent clearance of HDV can also occur spontaneously in untreated patients. 26 At variance with the delayed clearance of HBsAg after spontaneous or standard IFN-induced clearance of HDV RNA from serum, [21][22][23][24][25][26][27] in the present study none of the patients treated with PEG-IFN who achieved a sustained response cleared this antigen, possibly because of the relatively short posttreatment follow-up.…”

Efficacy of interferon α‐2b and lamivudine combination treatment in comparison to interferon α‐2b alone in chronic delta hepatitis: A randomized trial

“…1,2 Patients benefit from high doses and prolonged courses of IFN therapy. [3][4][5][6][7][8] As hepatitis delta virus (HDV) requires HBsAg for its replication, the abatement of hepatitis B virus (HBV) with potent antiviral agents may theoretically also suppress HDV. Lamivudine (an oral nucleoside analog) has been shown to achieve suppression of HBV DNA in up to 80% of patients after 6 months of therapy.…”

Interferon Alpha-2b Therapy in Chronic Hepatitis Delta

“…A few studies evaluated the response rate to IFN α treatment in CHD but their results are difficult to interpret because of differences in their study design and patient characterization. Additionally, most studies, which evaluated the efficacy of IFN therapy in CHD, consisted of a small number of patients (less than 25 individuals) (6, 16, 17). However, the majority of these studies showed biochemical and histological improvement but virological response had only occurred in a minority of patients (16, 18, 19).…”

“…Interestingly, among patients achieving SVR in the current study, one female patient cleared HBV and HDV simultaneously. In a study by Lau et al among the 6 HBV/HDV coinfected patients who completed at least 11 months of treatment with IFN α-2b, four cases lost serum HBsAg, while three of them developed anti-HBsAb (17). Some experts recommended prolonging IFN treatment duration until HBsAg loss in treatment responders and adjusting the IFN dose to patient tolerance (7, 26, 27).…”