Hepatitis D Treatment & Management
- Author: Praveen K Roy, MD, AGAF; Chief Editor: BS Anand, MD more...
Treatment for infection with hepatitis D virus (HDV) consists primarily of supportive measures. Observe synthetic liver function markers and mental status closely. Deterioration of either should prompt early consultation with hospital personnel capable of performing liver transplantation.
Liver transplantation is indicated in patients with fulminant liver failure. Patients with evidence of decompensated liver disease or fulminant liver failure should be immediately transferred to a center capable of performing a liver transplantation.
No pharmacologic treatment for HDV has been approved. However, a study of the efficacy of peginterferon alfa-2a (PEG-IFNa2a) found that treatment with or without adefovir over 48 weeks resulted in sustained HDV RNA clearance in approximately one fourth of patients.
No vaccine is available for HDV, but the hepatitis B virus (HBV) vaccination is effective against HDV.
See the following articles for more information:
Outpatient and follow-up care
Follow-up is recommended for at least 6 months to determine if chronic HBV and HDV infection develop.
Perform a liver biopsy to stage liver disease prior to beginning interferon alfa therapy.
Treatment with interferon can be continued after the 1-year period if well tolerated and efficacy is demonstrated. Monitoring HDV RNA and hepatitis B surface antigen (HBsAg) levels may help in guiding therapy.
Diet need not be restricted. If enteral intake is poor, intravenous fluids can be administered. Total parental nutrition is seldom needed.
Early notification of a hepatologist or gastroenterologist is warranted.
Rizzetto M, Verme G. Delta hepatitis--present status. J Hepatol. 1985. 1(2):187-93. [Medline].
Bean P. Latest discoveries on the infection and coinfection with hepatitis D virus. Am Clin Lab. 2002 Jun. 21(5):25-7. [Medline].
Smedile A, Casey JL, Cote PJ, et al. Hepatitis D viremia following orthotopic liver transplantation involves a typical HDV virion with a hepatitis B surface antigen envelope. Hepatology. 1998 Jun. 27(6):1723-9. [Medline].
Samuel D, Zignego AL, Reynes M, et al. Long-term clinical and virological outcome after liver transplantation for cirrhosis caused by chronic delta hepatitis. Hepatology. 1995 Feb. 21(2):333-9. [Medline].
Romeo R, Del Ninno E, Rumi M, et al. A 28-year study of the course of hepatitis delta infection: a risk factor for cirrhosis and hepatocellular carcinoma. Gastroenterology. 2009 May. 136(5):1629-38. [Medline].
Heidrich B, Deterding K, Tillmann HL, Raupach R, Manns MP, Wedemeyer H. Virological and clinical characteristics of delta hepatitis in Central Europe. J Viral Hepat. 2009 Dec. 16(12):883-94. [Medline].
Makuwa M, Mintsa-Ndong A, Souquiere S, Nkoghe D, Leroy EM, Kazanji M. Prevalence and molecular diversity of hepatitis B virus and hepatitis delta virus in urban and rural populations in northern Gabon in central Africa. J Clin Microbiol. 2009 Jul. 47(7):2265-8. [Medline]. [Full Text].
Wedemeyer H, Yurdaydin C, Dalekos GN, Erhardt A, Çakaloglu Y, Degertekin H, et al. Peginterferon plus adefovir versus either drug alone for hepatitis delta. N Engl J Med. 2011 Jan 27. 364(4):322-31. [Medline].
Manesis EK, Schina M, Le Gal F, et al. Quantitative analysis of hepatitis D virus RNA and hepatitis B surface antigen serum levels in chronic delta hepatitis improves treatment monitoring. Antivir Ther. 2007. 12(3):381-8. [Medline].