Hepatitis D Treatment & Management

Updated: Mar 03, 2020
  • Author: Praveen K Roy, MD, AGAF; Chief Editor: BS Anand, MD  more...
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Approach Considerations

Treatment for infection with hepatitis D virus (HDV) consists primarily of supportive measures (in part owing to the fact that HDV is very host dependent and absent of potentially drugable enzyme in its genome [20] ). 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. Peginterferon alfa-2a (PEG-IFNa2a) and nucelos(t)ide analogues have been used to manage chronic HBV infection, but only PEG-IFN has shown anti-HDV activity. [8, 21, 22] However, a study of the efficacy of PEG-IFNa2a found that treatment with or without adefovir over 48 weeks resulted in sustained HDV RNA clearance in approximately one fourth of patients. [23] In another study, PEG-IFN achieved sustained viral response (SVR) and remission in only 29.4% of patients. [24] Thus, PEG-IFN2a has low rates of SVR and clinical improvement. [22] The efficacy rate of interferon-based therapy does not exceed 30%, with frequent termination of therapy owing to serious side effects, and the relapse rate is very high. [8]

Potential new therapies remain under investigation, including prenylation inhibitors (against HDV only), as well as viral entry inhibitors and HBsAg-release inhibitors (against HDV and hepatitis B virus [HBV] coinfection) [8, 25, 26]

Early notification of a hepatologist or gastroenterologist is warranted.

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

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



Cost-effective, optimal strategies to reduce the prevalence of hepatitis B virus (HBV) in moderately endemic hepatitis D virus (HDV) regions include the implementation of all four of the following interventions [18] :

  • Testing, with HBV adult vaccination (diagnosis)

  • Diagnosis, with anti-HBV therapy (mono-infections)

  • Diagnosis, with combined anti–HBV-HDV therapy (dual infections)

  • Creation and utilization of effective awareness programs


Long-Term Monitoring

Follow-up is recommended for at least 6 months to determine if chronic hepatitis B virus (HBV) and hepatitis D virus (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. [27]