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This review comes from the Maimonides Medical Centre in New York – named after that great medieval physician philosopher who taught us that our certainties today may no longer be valid tomorrow. How is that for a CME motto. This is the most recent summary of Hepatitis D natural history and treatment I can find .
Hepatitis D virus (HDV) is a subviral satellite with hepatitis B virus (HBV) as its natural helper virus. After entry into hepatocytes, it utilizes host cellular enzymes to replicate by a double-rolling-circle mechanism. HDV is most often transmitted by contact with contaminated blood and body fluid, similar to HBV infection. Approximately 5% of the global HBV carriers are coinfected with HDV, leading to a total of 10-15 million HDV carriers worldwide.
1 Natural course and treatment of hepatitis D virus infection.
Hsieh TH, Liu CJ, Chen DS, Chen PJ.
J Formos Med Assoc. 2006 Nov;105(11):869-81. Review.
PMID: 17098688
This article is from the world’s top Hepatology journal, the ‘house’ journal of the American Association for the Study of Liver Diseases (AASLD) and published by John Wiley - No ‘Open Access’ here. But free for HINARI countries. The focus is on virology, drug effects and genetics. Probably the best overview of the field just now.
2 Treatment of chronic hepatitis D: New advances, old challenges.
Farci P.
Hepatology. 2006 Sep;44(3):536-9. No abstract available.
PMID: 16941704
Italians play a special role in HDV I thi nk - Rizetto M was the first to discover and describe HDV. It’s in Hepatology again so no open access but OK for HINARI countries.
Therapy of chronic hepatitis delta with standard interferon therapy has met with limited efficacy. This study was designed to examine the efficacy and safety of peginterferon with or without ribavirin. The authors conclude that : “a prolonged course of peginterferon alpha-2b resulted in clearance of serum HDV RNA and ALT normalization in a fifth of patients with chronic hepatitis D, while ribavirin had no effect on the viral clearance rate. Overall tolerance of therapy was poor.
3 Pegylated interferon alpha-2b as monotherapy or in combination with ribavirin in chronic hepatitis delta.
Niro GA, Ciancio A, Gaeta GB, Smedile A, Marrone A, Olivero A, Stanzione M, David E, Brancaccio G, Fontana R, Perri F, Andriulli A, Rizzetto M.
Hepatology. 2006 Sep;44(3):713-20.
PMID: 16941685
Chronic hepatitis D is difficult to treat. This pilot study investigated the efficacy and tolerability of pegylated PEG)-interferon (IFN)-alpha2b in chronic hepatitis D.
The results suggest that PEG-IFN-alpha2b is a promising treatment option in chronic hepatitis D. Non-responders could be identified by a less than 3 log decrease of HDV RNA at 6 months of treatment.
4 Treatment of chronic hepatitis delta with pegylated interferon-alpha2b.
Erhardt A, Gerlich W, Starke C, Wend U, Donner A, Sagir A, Heintges T, Haussinger D.
Liver Int. 2006 Sep;26(7):805-10.
PMID: 16911462
A focus on Pakistan. The global epidemiology of hepatitis delta virus (HDV) infection is changing. Their study shows that HDV infection is present in 16.6% of hepatitis B infected patients in Pakistan, most commonly in younger males living in rural areas; and (ii) delta virus infected patients have less severe clinical liver disease compared to delta negative, hepatitis B patients.
5 Epidemiology and clinical pattern of hepatitis delta virus infection in Pakistan.
Mumtaz-K, Hamid-S-S, Adil-S, Afaq-A, Islam-M, Abid-S, Shah-H-A,
Jafri-W.
Journal of Gastroenterology and Hepatology J-GASTROENTEROL-HEPATOL,
200520/10 (1503-1507)
PMID 16174065
Free full text – thank you to the Indian Journals of Medical Virology. No study sofar has looked at changing epidemiology of HDV infection in India. Elsewhere there are suggestions of a decline in seroprevalence. The results of this survey in patients with HBV related liver diseases in New Delhi also suggest a trend towards declining prevalence.
6 Seroprevalence of hepatitis D virus in patients with hepatitis B virus-related liver diseases.
Chakraborty-P, Kailash-U, Jain-A, Goyal-R, Gupta-R-K, Das-B-C, Kar-P.
Indian Journal of Medical Research 2005, 122/3 ; 254-257
PMID 16251784
An earlier study revealed a high prevalence of hepatitis B surface antigen (HBsAg) and hepatitis delta virus (HDV) in healthy individuals in Ulaanbaatar. This follow up study in the same cohort but using a new technique (enzyme-linked immunosorbent assay using recombinant hepatitis delta antigen protein expressed in the pupae of silkworm as the antigen probe) confirmed the extremely high prevalence of HDV infection in Mongolia.
No full text for free but you might try the authors at the Jichi Medical School, Tochigi-Ken, Japan.
7 High prevalence of hepatitis delta virus infection detectable by enzyme immunoassay among apparently healthy individuals in Mongolia.
Inoue-J, Takahashi-M, Nishizawa-T, Narantuya-L, Sakuma-M, Kagawa-Y,
Shimosegawa-T, Okamoto-H.
Journal of Medical Virology , 2005,. 76/3 ; 333-340
PMID 15902700
Inoue-J, Takahashi-M, Nishizawa-T, Narantuya-L, Sakuma-M, Kagawa-Y,
Shimosegawa-T, Okamoto-H.
Journal of Medical Virology , 2005,. 76/3 ; 333-340
PMID 15902700