hepatitis-delta

THE BURDEN OF HEPATITIS DELTA

Hepatitis delta virus (HDV): the most severe form of chronic viral hepatitis1,2

  • • Leads to rapid progression of liver disease
  • • 12-60 million people are infected with HDV globally
  • • Risk of progression to chronic hepatitis: 76%
  • • Cirrhosis within 5 years
  • • Hepatocellular carcinoma within 10 years

People with chronic hepatitis B face increased risk of death from cirrhosis and liver cancer, but those also infected with hepatitis Delta have even greater risk.

Compared with HBV-monoinfected patients, patients also infected with hep delta have 2-3x more likely to develop cirrhosis; 3-6x higher risk for hepatocellular carcinoma; 2x more likely to develop hepatic decompensation, liver transplantation or death3.


INCREASED RISK OF LONG-TERM CONSEQUENCES OF VIRAL HEPATITIS IN HBV/HDV PATIENTS VERSUS HBV MONOINFECTION3

BE-UNB-0824 EN increased risk

PREVALENCE


HEPATITIS DELTA: RARE OR UNDERDIAGNOSED?

Recent data suggest that hepatitis delta virus affects 12-60 millions of people around the globe.


HEPATITIS DELTA VIRUS AFFECTS 12-60 MILLIONS OF PEOPLE AROUND THE GLOBE1,3-5


BE-UNB-0824 EN epidemiology en legend

THE PREVALENCE OF HDV IS LIKELY UNDERESTIMATED3

Several factors contribute to the lack of accurate estimates.


BE-UNB-0824 EN underestimation factors

WHAT IS HEPATITIS DELTA?

DISEASE MECANISM

To help you better understand the mechanism of the disease, watch the video below:



HEPATITIS DELTA VIRUS IS AN INFECTIOUS DISEASE THAT REQUIRES THE PRESENCE OF HBV

HDV requires HBV surface antigen (HBsAg) as a surface protein to disseminate infection inside liver cells6

Once inside, the hepatitis delta virus genome (1.7 kb) is too small to code for the proteins required for its own replication and relies on the host machinery of liver cells to divide6

THE HEPATITIS DELTA VIRION


hepatitis-delta-virus


THE INFECTIVITY OF HDV*8


hepatitis-delta-besmettelijkheid


HDV gains entry into uninfected hepatocytes using the HBsAg envelope

  1. 1. L-HBsAg binds to the NTCP receptor
  2. 2. This triggers cell entry resulting in the release of HDV ribonucleic protein into the hepatocyte
  3. 3. HDV replication occurs

* Adapted from ref 8. ** As recommended by EASL, AASLD and the FDA

INTERPLAY BETWEEN HDV AND HBV

HDV tends to suppress HBV replication.
However, HBV viral load does not affect HDV viral load.
Treatment with NAs is ineffective in HDV.

​

HEPATITIS DELTA IS A BLOOD-BORNE VIRUS THAT CAN BE TRANSMITTED THROUGH SEVERAL ROUTES4,9

Contact with infected blood

    Sources can include:
  • •  Intravenous drug use
  • •  Tattoo placed with nonsterile material
  • •  Contact with blood products (eg, recipients of hemodialysis)
    • Sexual contact with an infected individual
    Mother-child transmission (rare)

NON-DISEASE-SPECIFIC SYMPTOMS THAT MAY OCCUR IN A HEPATITIS DELTA INFECTION10

  • •  Fever
  • •  Fatigue
  • •  Loss of appetite
  • •  Nausea
  • •  Vomiting
  • •  Abdominal pain
  • •  Dark urine
  • •  Clay-colored bowel movements
  • •  Joint Pain
  • •  Jaundice

Screening

BECAUSE OF THE SEVERITY OF HDV, SCREENING IS URGENTLY NEEDED

Screening HBV patients helps identify those who can be offered appropriate management11

EASL guidelines recommend that ALL HBV-infected patients should be screened for HDV 12

Recommendations AFEF 202013

  • • All HBV carriers should be screened for HDV infection.
  • • This screening should be periodic in populations at risk (drug addiction, multiple sexual partners)

HDV SCREENING IS CRITICAL TO IDENTIFY HBV-POSITIVE INDIVIDUALS AT RISK FOR RAPID DISEASE PROGRESSION14,15

Screening and diagnosis for HDV involves two steps:

  • HDV antibody testing – screening for prior/current HDV infection
  • HDV RNA testing – confirm active HDV infection

A blood test, called an HDV antibody test, is used to find out if someone has ever been infected with the hepatitis D virus. The HDV antibody test, sometimes called the anti-HDV test, looks for antibodies to the hepatitis D virus in blood. Antibodies are chemicals released into the bloodstream when someone gets infected. Test results can take anywhere from a few days to a few weeks to come back.

If the antibody test is reactive or positive, you need an additional test to see if you currently have hepatitis D. This test is called a nucleic acid test (NAT) for HDV RNA. Another name used for this test is a PCR test.

If the HDV RNA test is positive - you now have the virus in your blood.

HDV TREATMENT GOALS

Reduction in HDV RNA levels, which typically leads to a normalization of ALT levels16
Improvement of quality of live
Control disease progression

Achieving treatment goals aims to prevent long-term complications of HDV, including7:

  • • cirrhosis
  • • hepatocellular carcinoma
  • • liver transplantation
  • • liver-related death
References
  1. Miao Z, et al. J Infect Dis 2020;221:1677–87;
  2. Stockdale AJ, et al. J Hepatol 2020;73:523–32;
  3. Da BL, Heller T, Koh C. Hepatitis D infection: from initial discovery to current investigational therapies. Gastroenterol Rep (Oxf). 2019;7(4):231-245. doi:10.1093/gastro/goz023;
  4. World Health Organization. Hepatitis D. June 24, 2022, Available at: https://www.who.int/news-room/fact-sheets/detail/hepatitis-d (Accessed April 2023).
  5. E. Ho, et al. Coinfection of Hepatitis B and Hepatitis Delta Virus in Belgium, J. of Med Virology 85:1513–1517 (2013).
  6. Lok AS, Negro F, Asselah T, Farci P, Rizzetto M. Endpoints and new options for treatment of chronic hepatitis D. Hepatology. 2021;74(6):3479-3485. doi:10.1002/hep.32082.
  7. Farci P, Niro GA. Current and future management of chronic hepatitis D. Gastroenterol Hepatol (NY). 2018;14(6):342-351.
  8. Gilman C, et al. World J Gastroenterol 2019;25:4580–97 * Adapted from ref 8. ** As recommended by EASL, AASLD and the FDA.
  9. Niro GA, Ferro A, Cicerchia F, et al. Hepatitis delta virus: from infection to new therapeutic strategies. World J Gastroenterol. 2021;27(24):3530-3542. doi:10.3748/wjg.v27.i24.3530.
  10. Centers for Disease Control and Prevention. What is Hepatitis D – FAQ. Available at: www.cdc.gov/hepatitis/hdv/hdvfaq.htm (accessed April 2023).
  11. Terrault NA, Ghany MG. Enhanced screening for hepatitis D in the USA: overcoming the delta blues. Dig Dis Sci. 2021;66:2483-2485. doi:10.1007/s10620-020-06584-w.
  12. European Association for the Study of the Liver. EASL 2017 Clinical practice guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67(2):370-398. doi:10.1016/j. jhep.2017.03.021.
  13. AFEF. Recommandations pour le diagnostic et le suivi non invasif des maladies chroniques du foie. Juillet 2020.
  14. Ahn J, Gish RG. Hepatitis D virus: a call to screening. Gastroenterol Hepatol (NY). 2014;10(10):647-686.
  15. Moore A, Mitchell J, Reau N. Clinicians fail to screen for HDV in patients with HBV despite guideline recommendations: 989. Am J Gastroenterol. 2019;114(Supplement):S574-S575. doi:10.14309/01.ajg.0000593492.8131.
  16. Farci P, Niro GA. Current and future management of chronic hepatitis D. Gastroenterol Hepatol (NY). 2018;14(6):342-351.
  17. Wedemeyer H, Hardtke S, Manns MP. Treatment of hepatitis delta. Clin Liv Dis. 2013;2(6):237-239.

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