Daily Times

KARACHI: Currently there is no effective antiviral treatment for hepatitis D. Pakistan is also among high-prevalence areas. Hepatitis D virus (HDV) is a ribonucleic acid (RNA) virus that requires hepatitis B virus (HBV) for its replication. HDV infection occurs only simultaneously or as super-infection with HBV, according to a WHO Geneva report.

The virus is transmitted through contact with the blood or other body fluids of an infected person. Vertical transmission from mother to child is rare. Approximately 15 million people across the world are chronically coinfected with HDV and HBV. Hepatitis D infection can be prevented by hepatitis B immunization.

Hepatitis D is a liver disease in both acute and chronic forms caused by the hepatitis D virus (HDV) that requires HBV for its replication. Hepatitis D infection cannot occur in the absence of hepatitis B virus. High-prevalence areas include the Mediterranean, Middle East, Pakistan, Central and Northern Asia, Japan, Taiwan, Greenland and parts of Africa (mainly the horn of Africa and West Africa), the Amazon Basin and certain areas of the Pacific. Prevalence is low in North America and Northern Europe, South Africa, and Eastern Asia.

Chronic HBV carriers are at risk for infection with HDV. People who are not immune to HBV (either by natural disease or immunization with the hepatitis B vaccine) are at risk of infection with HBV which puts them at risk of HDV infection. HDV infection is diagnosed by high titres of Immunoglobulin G (IgG) and Immunoglobulin M (IgM) anti-HDV, and confirmed by detection of HDV RNA in serum. However, HDV diagnostics are not widely available and there is no standardization for HDV RNA assays, which are used for monitoring response to antiviral therapy.

There is no specific treatment for acute or chronic HDV infection. Persistent HDV replication is the most important predictor of mortality and the need for antiviral therapy. Pegylated interferon alpha is the only drug effective against HDV; antiviral nucleotide analogues for HBV have no or limited effect on HDV replication. The optimal duration of therapy is not well defined, nor how long patients need to be HDV RNA negative after the end of therapy to achieve a sustained virological response. More than 1 year of therapy may be necessary.

The overall rate of sustained virological response remains low, including in children, and most patients relapse after discontinuation of therapy. Liver transplantation may be considered for cases of fulminant hepatitis and end-stage liver disease. New therapeutic agents and strategies are needed, and novel drugs, such as prenylation inhibitor or HBV entry inhibitors, have shown early promise.

Prevention and control of HDV infection requires prevention of HBV transmission through hepatitis B immunization, blood safety, injection safety, and harm reduction services. Hepatitis B immunization does not provide protection against HDV for those already HBV infected.

Published in Daily Times, August 1^st , 2017.