Treatment of Chronic Delta Hepatitis: A Nine-Year Retrospective Analysis

Abstract

A B S T R A C TBackground: Chronic delta hepatitis is the most severe form of viral hepatitis, for which interferon administration is the only available treatment. However, the efficacy of interferon treatment is affected by the dose and duration of treatment, and relapse rates are high. Objectives: In this study, we sought to evaluate the efficacy of treatment with pegylated interferon and observe the relapse rates of delta hepatitis after treatment. Patients and Methods: Forty-six patients with chronic delta hepatitis were retrospectively studied between January 2002 and December 2010. Patients were evaluated for biochemical, virological, and histological responses. They were then followed-up for at least 1 year after discontinuation of the treatment. Results: All the 46 patients in the study received PEG-IFN therapy. Of the 46 patients, 25 were treated with PEG-IFN for 1 year and 21 were treated for 2 years. Sixteen patients (34.7%) showed a biochemical response, 27 (58.6%) showed a virological response, and 39 (84.7%) showed a histological response. Sustained virological and biochemical responses were achieved in 41% and 47.8% of the patients, respectively. Sixteen (84.2%) patients of the 19 with high levels of hepatitis delta virus RNA (HDV RNA) (HDV RNA level > 1 × 105) and 10 (71.4%) of the 14 patients with high titers of hepatitis B surface antigen (HbsAg) (HbsAg > 102 IU/mL) at the beginning of the treatment showed relapse after treatment. Conclusions: We found no significant differences between 1-year and 2-year treatments. However, the relapse rate was lower in the 2-year treatment group. Higher HDV RNA and HbsAg levels before treatment were associated with higher relapse rates. Younger age was a significant factor in predicting response.

Liver Transplantation in Hepatitis Delta: South America Experience

“…HDV reaches a higher prevalence between the third and fourth decades of life (7) . The average age of individuals diagnosed with hepatitis D varies between 30 and 44 years old (8,9) . Because hepatitis B is endemic in the Amazon region and often affects individuals in childhood, the disastrous consequences of association with delta virus can be noted in the second decade of life (10) .…”

Interferon‐based treatment of chronic hepatitis D

“…46 Selected published studies are displayed in Table 1 including patients with chronic HDV infection who were treated with pegylated interferon-alfa-based treatment for at least 48 weeks and followed up for a minimum of 6 months. [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] The Hepatitis Delta International Intervention Trials (HIDIT-I and HIDIT-II) explored pegylated interferon-alfa-2a either in combination with adefovir or with tenofovir for 48 or 96 weeks in patients with HDV infections. 52,56 The trials were performed in Germany, Turkey, Greece and Romania.…”

“…The combination of pegylated interferon‐alfa and ribavirin for 72 weeks did not lead to an improved virological or biochemical response rate with overall poor therapy tolerance 46 . Selected published studies are displayed in Table 1 including patients with chronic HDV infection who were treated with pegylated interferon‐alfa‐based treatment for at least 48 weeks and followed up for a minimum of 6 months 45–59 …”

Future anti‐HDV treatment strategies, including those aimed at HBV functional cure

“…PEG-IFN was the only available treatment that existed for HDV until recently. The evidence for this comes from a series of four randomized controlled trials and nine cohort studies [39][40][41][42][43][44][45][46][47][48][49][50][51] of HBV/HDV patients between 2006 and 2019. A recent meta-analysis by Abdrakhman et al 52 showed that PEG-IFN treatment had an estimated SVR risk difference of 0.29 [95% CI 0.24-0.34] for HDV RNA clearance over placebo, at 24 weeks off therapy.…”