Hepatitis D Treatment & Management

Author: Praveen K Roy, MD, AGAF; Chief Editor: Julian Katz, MD more...

Updated: Dec 2, 2011

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Approach Considerations

Treatment consists primarily of support. 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 treatment for hepatitis D virus (HDV) has been approved.

However, a study of the efficacy of peginterferon alfa-2a found that treatment with or without adefovir over 48 weeks resulted in sustained HDV RNA clearance in approximately one fourth of patients.^[9]

No vaccine is available for HDV, but the HBV vaccination is effective against HDV.

See the following 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 HBsAg levels may help in guiding therapy.^[10]

Diet

Diet need not be restricted. If enteral intake is poor, intravenous fluids can be administered. Total parental nutrition is seldom needed.

Consultations

Early notification of a hepatologist or gastroenterologist is warranted.

Proceed to Medication

Contributor Information and Disclosures

Author

Praveen K Roy, MD, AGAF Gastroenterologist, Ochsner Clinic Foundation; Adjunct Associate Research Scientist, Lovelace Respiratory Research Institute; Editor-in-Chief, The Internet Journal of Gasteroenterology; Editorial Board, Signal Transduction Insights; Editorial Board, The Internet Journal of Epidemiology; Editorial Board, Gastrointestinal Endoscopy Review Letter

Praveen K Roy, MD, AGAF is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, and American Society of Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Coauthor(s)

Sean R Lacey, MD Associate Professor of Gastroenterology, Pennsylvania State University College of Medicine

Sean R Lacey, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, and American Gastroenterological Association

Disclosure: astra zenaca Honoraria Speaking and teaching

Chief Editor

Julian Katz, MD Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

David Eric Bernstein, MD Director of Hepatology, North Shore University Hospital; Professor of Clinical Medicine, Albert Einstein College of Medicine

David Eric Bernstein, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

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Bean P. Latest discoveries on the infection and coinfection with hepatitis D virus. Am Clin Lab. Jun 2002;21(5):25-7. [Medline].
Xiridou M, Borkent-Raven B, Hulshof J, Wallinga J. How hepatitis D virus can hinder the control of hepatitis B virus. PLoS One. 2009;4(4):e5247. [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. Jun 1998;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. Feb 1995;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. May 2009;136(5):1629-38. [Medline].
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Wedemeyer H, Yurdaydìn 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. Jan 27 2011;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].

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