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Hepatitis D Treatment & Management

  • Author: Praveen K Roy, MD, AGAF; Chief Editor: BS Anand, MD  more...
 
Updated: Apr 30, 2015
 

Approach Considerations

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.[9]

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.[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.

 
 
Contributor Information and Disclosures
Author

Praveen K Roy, MD, AGAF Chief of Gastroenterology, Presbyterian Hospital; Medical Director of Endoscopy, Presbyterian Medical Group; Adjunct Associate Research Scientist, Lovelace Respiratory Research Institute

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

Disclosure: Nothing to disclose.

Coauthor(s)

Sean R Lacey, MD Associate Professor of Gastroenterology, Pennsylvania State University College of Medicine; Staff Physician, Division of Gastroenterology, Lehigh Valley Hospital and St Luke's Hospital

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

Disclosure: Nothing to disclose.

Rajan Kanth, MD Hospitalist, Ministry Saint Joseph’s Hospital

Rajan Kanth, MD is a member of the following medical societies: American College of Physicians, Society of Hospital Medicine, Nepal Medical Association

Disclosure: Nothing to disclose.

Rahaman Mujibur, MD Academic Hospitalist/Hospitalist, Marshfield Clinic, St Joseph’s Hospital

Rahaman Mujibur, MD is a member of the following medical societies: American College of Physicians, American Medical Association, Wisconsin Medical Society

Disclosure: Nothing to disclose.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

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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  8. 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].

  9. 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].

  10. 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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