The burden of hepatitis D – defogging the epidemiological horizon

Wedemeyer, Heiner

doi:10.1016/j.jhep.2020.06.037

Cited by 11 publications

(10 citation statements)

References 21 publications

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“…13 Nevertheless, the lack of universal testing of all HBsAg-positive individuals and missing data from large areas of the world still represent important causes of uncertainties on the global HDV prevalence. 3,13…”

Section: The Current Hdv Epidemi Ologymentioning

confidence: 99%

“…1 Although the introduction of universal anti-HBV vaccination has resulted in an initial decline in HDV circulation, in the last decade HDV seroprevalence has shown a stable trend mainly fuelled by immigration from highly endemic areas. 2,3 While the simultaneous infection by HBV and HDV usually evolves towards the clinical resolution of both viral infections, a different scenario is observed in superinfection in which HBV-infection provides the adequate virologic background for rapid HDV spread, setting the basis for the establishment of a chronic HDV-infection. 4 Chronic HDV-infection can pose major clinical challenges since it can rapidly progress towards cirrhosis and subsequently to liver decompensation and hepatocellular carcinoma (HCC).…”

Section: Introductionmentioning

confidence: 99%

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Novel concepts on mechanisms underlying Hepatitis Delta virus persistence and related pathogenesis

Salpini

D’Anna

Piermatteo

et al. 2022

Journal of Viral Hepatitis

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Hepatitis Delta virus is the smallest known human virus, exploiting the HBV surface proteins (HBsAg) for the release of its progeny and de novo entry into hepatocytes. Ever growing evidence have highlighted the existence of multiple mechanisms underlying HDV persistence including integrated HBV‐DNA as a source of HBsAg production and the capability of the HDV genome to propagate through cell proliferation, thus supporting a potential HDV persistence even in the absence of HBV. Chronic HDV‐infection causes the most severe form of viral hepatitis, leading to the development of cirrhosis in 15% of cases within 1–2 years and in 50%–60% of cases within 5–10 years. The rates of hepatocellular carcinoma and hepatic decompensation are also 2–3‐fold higher than for HBV mono‐infection. There is the evidence that persistent viral replication plays a key role in triggering liver injury, suggesting the existence of direct viral cytopathic properties that can modulate, synergistically with immune‐responses, the progression towards end‐stage liver diseases. All these aspects can be further exacerbated by the extraordinary degree of viral genetic variability that can promote HDV evasion from immune responses and has enabled viral differentiation into genotypes and subgenotypes with potential different pathobiological properties. In this light, this review aims at providing comprehensive insights of mechanisms (with a focus on virological factors) underlying HDV persistence and pathogenesis, critical in shaping the clinical outcome of the infection. Dissecting these mechanisms is pivotal to optimize therapeutic strategies aimed at fully counteracting this fascinating and fearsome virus.

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Section: The Current Hdv Epidemi Ologymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Novel concepts on mechanisms underlying Hepatitis Delta virus persistence and related pathogenesis

Salpini

D’Anna

Piermatteo

et al. 2022

Journal of Viral Hepatitis

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“…Recent progress in the virology and immunology of this disease, as well as emerging drug developments have redirected the attention of the hepatology community to focus on HDV. Indeed, the latest global epidemiological data show that the prevalence of HDV is probably much higher than previously thought 1 …”

Section: Introductionmentioning

confidence: 93%

“…Results of clinical trials for new treatment approaches are encouraging, in particular for specific entry inhibitors and prenylation inhibitors, while other options such as interferon lambda polymers and novel HBV treatments targeting Toll‐like ligands and check‐point inhibitors may also be beneficial 3 . In any case, these findings may represent an important breakthrough in the history of HDV infection 1 and in the battle against this disease as its burden continues to rise.…”

Section: Introductionmentioning

confidence: 99%

Is hepatitis delta underestimated?

Papatheodoridi

Papatheodoridis

2021

Liver International

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Hepatitis D virus may be underestimated because it is a significant problem in HBsAg‐positive patients, especially those who inject drugs, have HIV or HCV co‐infections and/or live in certain endemic regions. In the past few decades, the prevalence of HDV was expected to have decreased as a result of improvements in public healthcare policies and universal HBV vaccination programs. However, HDV has continued to spread in low‐income countries, with local outbreaks and migration to less endemic areas, so that its prevalence has remained stable or even increased in certain regions. As a result, research has been focused on the epidemiology of HDV. Contradicting data from three large recent meta‐analyses have reported that the prevalence of HDV may be between 0.16% and 1.00% in the global general population, and 4.5% and 14.6% in HBsAg‐positive patients, with an estimated 12 to 70 million HDV patients worldwide. The exact prevalence and estimated number of HDV patients is still a subject of debate for several reasons, including the unreliable assessment of the infection and a lack of real‐world screening. HDV infection is associated with an increased risk of progression to cirrhosis and the development of HCC compared to patients with HBV mono‐infection, a risk which is even higher in patients with HIV co‐infection. Morbidity and mortality from HDV‐related cirrhosis should not be overlooked. In conclusion, hepatitis D virus is probably underestimated and certainly underdiagnosed, and screening for HDV should be performed in all HBsAg‐positive patients in clinical practice.

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“…Neben dem hohen HCC-Risiko sind die klinischen Verläufe bei einer Koinfektion mit HDV schwerer. Somit kommt dem Screening auf eine Koinfektion mit HDV eine wichtige Rolle zu [ 27 ]. Die Diagnose einer Hepatitis D ist aktuell umso wichtiger, als dass seit September 2020 mit dem Eintrittshemmer Bulevirtid erstmals eine zugelassene Therapieoption besteht [ 6 ].…”

Section: Mechanismen Der Karzinogeneseunclassified

Rolle der Hepatitis-B-Impfung in der Prävention des hepatozellulären Karzinoms

Dietz-Fricke

Wedemeyer

2021

Onkologe

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Hintergrund Die chronische Hepatitis-B-Infektion stellt einen wesentlichen Risikofaktor für die Entwicklung eines hepatozellulären Karzinoms (HCC) dar. Wenngleich sich die Therapiemöglichkeiten des HCC stetig verbessern, kommt präventiven Maßnahmen eine entscheidende Bedeutung zu. Schlussfolgerung Mit der Hepatitis-B-Impfung steht ein wirksames Mittel zur Verhinderung einer Infektion mit dem Hepatitis-B-Virus (HBV) zur Verfügung. Eine konsequente Impfung führt nicht nur zu einem Rückgang HBsAg-positiver Patienten, sondern bewirkt auch einen Rückgang der HCC-Inzidenz, wie bereits in den 1990er-Jahren in Taiwan gezeigt wurde. Ein suffizienter Schutz vor einer HBV-Infektion verhindert zudem die Infektion mit dem Hepatitis-D-Virus, das mit einem besonders hohen HCC-Risiko behaftet ist. Neuere Ansätze befassen sich auch mit dem therapeutischen Einsatz von Impfstoffen zur Behandlung bereits Infizierter. Wesentlich ist auch das Erkennen bestehender Virushepatitis-Erkrankungen, um Therapien zu beginnen und das HCC-Risiko zu minimieren.

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The burden of hepatitis D – defogging the epidemiological horizon

Cited by 11 publications

References 21 publications

Novel concepts on mechanisms underlying Hepatitis Delta virus persistence and related pathogenesis

Novel concepts on mechanisms underlying Hepatitis Delta virus persistence and related pathogenesis

Is hepatitis delta underestimated?

Rolle der Hepatitis-B-Impfung in der Prävention des hepatozellulären Karzinoms

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