Chapter 29
Treatment of Hepatitis D
Book Editor(s):Howard C. Thomas BSc, PhD, FRCP, FRCPath, FMedSci,
Anna S.F. Lok MD,
Stephen A. Locarnini MBBS, BSc(Hons), PhD, FRCPath,
Arie J. Zuckerman MD, DSc, FRCP, FRCPath, FMedSci,
Howard C. Thomas BSc, PhD, FRCP, FRCPath, FMedSci
Emeritus Professor of Hepatology, Department of Medicine, Imperial College London, London, UK
Search for more papers by this authorAnna S.F. Lok MD
Alice Lohrman Andrews Research Professor in Hepatology, Director of Clinical Hepatology, Professor of Internal Medicine, Associate Chair for Clinical Research, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
Search for more papers by this authorStephen A. Locarnini MBBS, BSc(Hons), PhD, FRCPath
Head, Research & Molecular Development, Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia
Search for more papers by this authorArie J. Zuckerman MD, DSc, FRCP, FRCPath, FMedSci
Emeritus Professor of Medical Microbiology, Formerly Principal and Dean, Royal Free Hospital School of Medicine
Search for more papers by this authorFirst published: 26 July 2013
Summary
Interferon is the only therapy with demonstrated efficacy for chronic hepatitis D. Nucleos(t)ide analogs against the hepatitis B virus (HBV) are not efficacious as they do not eradicate the underlying HBV that supports hepatitis D virus (HDV) infection. The current therapeutic recommendation is pegylated interferon alpha (PEG-IFNα) given weekly for 12 to 18 months. Response is limited. Serum HDVRNA is undetectable 6 months post therapy in only about one-quarter of patients; however, HDV may relapse in these patients as long as they remain HBsAg-positive. The only reliable endpoint of therapy is the clearance of hepatitis B surface antigen (HBsAg). The current management of HDV patients is based on common practice rather than on evidence from clinical trials; therefore, it should be pragmatic and individualized. Therapy lasting longer than 12 months might be of benefit in selected patients with partial responses or in those with rapidly advancing disease.
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