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Illescas-López M, Chaves-Blanco L, de Salazar A, Hernández-Febles M, Carracedo R, Lagarejos E, Fuentes A, Pereira S, Cea M, De La Iglesia A, Freyre C, Iborra A, Odero V, García-Barrionuevo A, Aguilera A, Pena MJ, García F. Assessment of performance and comparison of three commercial HDV RNA detection assays: implications for diagnosis and treatment monitoring. Front Cell Infect Microbiol 2024; 14:1422299. [PMID: 38988808 PMCID: PMC11233439 DOI: 10.3389/fcimb.2024.1422299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/05/2024] [Indexed: 07/12/2024] Open
Abstract
Objectives Precise HDV-RNA detection and quantification are pivotal for diagnosis and monitoring of response to newly approved treatment. We evaluate the performance of three HDV RNA detection and quantification assays. Methods Hepatitis Delta RT-PCR system kit, EurobioPlex HDV assay, and RoboGene HDV RNA Quantification kit 2.0 were used for testing 151 HBsAg-positive samples, 90 HDV-RNA negative and 61 HDV-RNA positive. We also evaluated serial dilutions of the WHO international standard for HDV, PEI 7657/12. All HDV-RNA positive samples were genotyped using a next-generation sequencing strategy. Results Qualitative results indicated a 100% concordance between tests. Quantitative results correlated well, r2 = 0.703 (Vircell-vs-Eurobio), r2 = 0.833 (Vircell-vs-RoboGene), r2 = 0.835 (Robogene-vs-Eurobio). Bias index was 2.083 (Vircell-vs-Eurobio), -1.283 (Vircell-vs-RoboGene), and -3.36 (Robogene-vs-Eurobio). Using the WHO IS, Vircell overestimated the viral load by 0.98 log IU/mL, Eurobio by 1.46 log IU/mL, and RoboGene underestimated it by 0.98 log IU/mL. Fifty-nine samples were successfully genotyped (Genotype 1, n=52; Genotype 5, n=7; Genotype 6, n=1), with similar results for correlation and bias. Conclusion This study underscores the necessity of using reliable HDV-RNA detection and quantification assays, as evidenced by the high concordance rates in qualitative detection and the observed variability in quantitative results. These findings highlight the importance of consistent assay use in clinical practice to ensure accurate diagnosis and effective treatment monitoring of HDV infection.
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Affiliation(s)
| | - Lucía Chaves-Blanco
- Servicio de Microbiología, Hospital Universitario San Cecilio, Granada, Spain
| | - Adolfo de Salazar
- Servicio de Microbiología, Hospital Universitario San Cecilio, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.Granada, Granada, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Melisa Hernández-Febles
- Servicio de Microbiología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Raquel Carracedo
- Servicio de Microbiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Eduardo Lagarejos
- Servicio de Microbiología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Ana Fuentes
- Servicio de Microbiología, Hospital Universitario San Cecilio, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.Granada, Granada, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Sara Pereira
- Servicio de Microbiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Maria Cea
- Servicio de Microbiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Carolina Freyre
- Servicio de Microbiología, Hospital de Puerto Real, Puerto Real, Spain
| | - Asunción Iborra
- Servicio de Microbiología, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Valle Odero
- Servicio de Microbiología, Hospital Universitario de Jerez de la Frontera, Jerez de la Frontera, Spain
| | | | - Antonio Aguilera
- Servicio de Microbiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - María José Pena
- Servicio de Microbiología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Federico García
- Servicio de Microbiología, Hospital Universitario San Cecilio, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.Granada, Granada, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Rodríguez-Tajes S, Palom A, Giráldez-Gallego Á, Moreno A, Urquijo JJ, Rodríguez M, Alvarez-Argüelles M, Diago M, García-Eliz M, Fuentes J, Martínez-Sapiña AM, Castillo P, Casado M, Pérez-Campos E, Muñoz R, Hernández-Conde M, Morillas RM, Granados R, Miquel M, Morillas MJ, García-Retortillo M, Carrión JA, Moreno JM, Montón C, González-Santiago JM, Lorente S, Cabezas J, Mateos B, Vázquez-Rodríguez S, Díaz-Fontenla F, Pinazo JM, Delgado M, Pérez-Palacios D, Horta D, Fernández-Marcos C, López C, Calleja JL, Fernández I, García-Samaniego J, Forns X, Buti M, Lens S. Characterizing Hepatitis Delta in Spain and the gaps in its management. GASTROENTEROLOGIA Y HEPATOLOGIA 2024:502222. [PMID: 38908682 DOI: 10.1016/j.gastrohep.2024.502222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 06/18/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND AND AIMS Chronic hepatitis D (CHD) is a severe form of chronic viral hepatitis. The estimated hepatitis delta prevalence in Spain is around 5% of patients with hepatitis B. Reimbursement of new antiviral therapies (Bulevirtide, BLV) was delayed in our country until February 2024. We aimed to characterize the clinical profile of patients with HDV/HBV infection in Spain and current barriers in their management at the time of BLV approval. METHOD Multicenter registry including patients with positive anti-HDV serology actively monitored in 30 Spanish centers. Epidemiological, clinical and virological variables were recorded at the start of follow-up and at the last visit. RESULTS We identified 329 anti-HDV patients, 41% were female with median age 51 years. The most common geographical origin was Spain (53%) and East Europe (24%). Patients from Spain were older and had HCV and HIV coinfection probably associated to past drug injection (p<0.01). HDV-RNA was positive in 138 of 221 assessed (62%). Liver cirrhosis was present at diagnosis in 33% and it was more frequent among viremic patients (58% vs 25%, p<0.01). After a median follow-up of 6 (3-12) years, 44 (16%) resolved infection (18 spontaneously and 26 after Peg-INF). An additional 10% of patients developed cirrhosis (n=137) during follow-up (45% had portal hypertension and 14% liver decompensation). Liver disease progression was associated to persisting viremia. CONCLUSION One-third of the patients with CHD already have cirrhosis at diagnosis. Persistence of positive viremia is associated to rapid liver disease progression. Importantly, barriers to locally determine/quantify HDV-RNA were present.
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Affiliation(s)
| | - Adriana Palom
- Hospital Universitari Vall d'Hebron, CIBEREHD, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | - Marta Casado
- Hospital Universitario Torrecárdenas, Almería, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Sara Lorente
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Joaquín Cabezas
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | | | | | - Mercè Delgado
- Hospital de Mataró Consorci Sanitari del Maresme, Mataró, Spain
| | | | | | | | | | | | | | | | - Xavier Forns
- Hospital Clínic, Universitat de Barcelona, IDIBAPS, CIBEREHD, Barcelona, Spain
| | - María Buti
- Hospital Universitari Vall d'Hebron, CIBEREHD, Barcelona, Spain
| | - Sabela Lens
- Hospital Clínic, Universitat de Barcelona, IDIBAPS, CIBEREHD, Barcelona, Spain.
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Kondili LA, Brancaccio G, Tosti ME, Coco B, Quaranta MG, Messina V, Ciancio A, Morisco F, Cossiga V, Claar E, Rosato V, Ciarallo M, Cacciola I, Ponziani FR, Cerrito L, Coppola R, Longobardi F, Biliotti E, Rianda A, Barbaro F, Coppola N, Stanzione M, Barchiesi F, Fagiuoli S, Viganò M, Massari M, Russo FP, Ferrarese A, Laccabue D, Di Marco V, Blanc P, Marrone A, Morsica G, Federico A, Ieluzzi D, Rocco A, Foschi FG, Soria A, Maida I, Chessa L, Milella M, Rosselli Del Turco E, Madonia S, Chemello L, Gentile I, Toniutto P, Bassetti M, Surace L, Baiocchi L, Pellicelli A, De Santis A, Puoti M, Degasperi E, Niro GA, Zignego AL, Craxi A, Raimondo G, Santantonio TA, Brunetto MR, Gaeta GB. A holistic evaluation of patients with chronic Hepatitis D virus (HDV) infection enrolled in the Italian PITER-B and delta cohort. Int J Infect Dis 2024; 146:107115. [PMID: 38801968 DOI: 10.1016/j.ijid.2024.107115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND AND AIMS We aimed to characterize the epidemiologic and comorbidities profiles of patients with chronic Hepatitis D (CHD) followed in clinical practice in Italy and explored their interferon (IFN) eligibility. METHODS This was a cross-sectional study of the PITER cohort consisting of consecutive HBsAg-positive patients from 59 centers over the period 2019-2023. Multivariable analysis was performed by logistic regression model. RESULTS Of 5492 HBsAg-positive enrolled patients, 4152 (75.6%) were screened for HDV, 422 (10.2%) were anti-HDV positive. Compared with HBsAg mono-infected, anti-HDV positive patients were more often younger, non-Italians, with a history of drug use, had elevated alanine transaminase (ALT), cirrhosis, or hepatocellular carcinoma (HCC). Compared with Italians, anti-HDV positive non-Italians were younger (42.2% age ≤ 40 years vs. 2.1%; P < 0.001), more often females (males 43.0% vs. 68.6%; P < 0.001) with less frequent cirrhosis and HCC. HDV-RNA was detected in 63.2% of anti-HDV-positive patients, who were more likely to have elevated ALT, cirrhosis, and HCC. Extrahepatic comorbidities were present in 47.4% of anti-HDV positive patients and could affect the eligibility of IFN-containing therapies in at least 53.0% of patients in care. CONCLUSIONS CHD affects young, foreign-born patients and older Italians, of whom two-thirds had cirrhosis or HCC. Comorbidities were frequent in both Italians and non-Italians and impacted eligibility for IFN.
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Affiliation(s)
- Loreta A Kondili
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy; UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy.
| | - Giuseppina Brancaccio
- Department of Molecular Medicine, Infectious Diseases, University of Padua, Padua, Italy
| | | | - Barbara Coco
- Hepatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Vincenzo Messina
- Department of Infectious Diseases, Sant'Anna Hospital, Caserta, Italy
| | - Alessia Ciancio
- Gastroenterology Unit, Città della Salute e della Scienza of Turin, University Hospital, Turin, Italy
| | - Filomena Morisco
- Liver and Biliary System Unit, Department of Clinical Medicine and Surgery, University of Naples, Naples, Italy
| | - Valentina Cossiga
- Liver and Biliary System Unit, Department of Clinical Medicine and Surgery, University of Naples, Naples, Italy
| | | | | | | | - Irene Cacciola
- Department of Internal Medicine, University Hospital of Messina, Messina, Italy
| | - Francesca Romana Ponziani
- Liver Unit, Digestive Disease Center, CEMAD Division of Internal Medicine and Gastroenterology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lucia Cerrito
- Liver Unit, Digestive Disease Center, CEMAD Division of Internal Medicine and Gastroenterology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberta Coppola
- Department of Hepatology, Gragnano Hospital, Gragnano (NA), Italy
| | | | - Elisa Biliotti
- National Institute for Infectious Diseases, Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Alessia Rianda
- National Institute for Infectious Diseases, Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - Francesco Barbaro
- Department of Medicine, Infectious Diseases Unit, University Hospital of Padua, Padua, Italy
| | - Nicola Coppola
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Stanzione
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Barchiesi
- Clinical Infectious Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Stefano Fagiuoli
- Department of Medicine, University of Milan Bicocca & Gastroenterology Hepatology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Mauro Viganò
- Department of Medicine, University of Milan Bicocca & Gastroenterology Hepatology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Marco Massari
- Malattie Infettive, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Paolo Russo
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padua, Padua, Italy
| | - Alberto Ferrarese
- Gastroenterology Unit, University Hospital Borgo Trento, Verona, Italy
| | - Diletta Laccabue
- Department of Medicine and Surgery, Università degli Studi di Parma, Parma, Italy
| | - Vito Di Marco
- Biomedical Department of Internal and Specialistic Medicine University of Palermo, Unit of Gastroenterology and Hepatology, Palermo, Italy
| | - Pierluigi Blanc
- Infectious Disease Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Aldo Marrone
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giulia Morsica
- Unit of Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Federico
- Hepato-Gastroenterology Division, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Alba Rocco
- Department of Clinical Medicine and Surgery, Hepato-Gastroenterology Unit, University of Naples Federico II, Naples, Italy
| | | | - Alessandro Soria
- Clinic of Infectious Diseases, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Ivana Maida
- Infectious and Tropical Diseases Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Luchino Chessa
- Liver Unit, University Hospital, Monserrato, Cagliari, Italy
| | - Michele Milella
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Elena Rosselli Del Turco
- Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Salvatore Madonia
- Department of Internal Medicine Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Liliana Chemello
- Department of Medicine-DIMED, Padua University, University Hospital, Padua, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Pierluigi Toniutto
- Hepatology and Liver Transplant Unit, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Matteo Bassetti
- Clinica Malattie Infettive, Università degli Studi di Genova, Policlinico S. Martino IRCCS, Genova, Italy
| | - Lorenzo Surace
- Ambulatorio di Epatologia e Infettivologia, Azienda Sanitaria Provinciale CZ-Distretto del Lametino, Lamezia Terme (CZ), Italy
| | | | | | - Adriano De Santis
- Department of Internal Medicine, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Massimo Puoti
- Infectious Disease Unit, Niguarda Hospital, Milan, Italy
| | | | - Grazia Anna Niro
- Division of Gastroenterology and Endoscopy, Fondazione IRCCS 'Casa Sollievo della Sofferenza', San Giovanni Rotondo, Foggia, Italy
| | - Anna Linda Zignego
- Department of Experimental and Clinical Medicine, Interdepartmental Centre MASVE, University of Florence, Italy
| | - Antonio Craxi
- Gastroenterology and Hepatology Unit, PROMISE, University of Palermo, Palermo, Italy
| | - Giovanni Raimondo
- Department of Internal Medicine, University Hospital of Messina, Messina, Italy
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Gopalakrishna H, Mironova M, Dahari H, Koh C, Heller T. Advances and Challenges in Managing Hepatitis D Virus: Evolving Strategies. CURRENT HEPATOLOGY REPORTS 2024; 23:32-44. [PMID: 38533303 PMCID: PMC10965034 DOI: 10.1007/s11901-024-00643-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 03/28/2024]
Abstract
Purpose of Review Hepatitis D Virus (HDV), although a small defective virus, poses a substantial public health challenge due to lack of awareness, underrecognized prevalence, and limited treatment options. Universal HDV screening within hepatitis B virus (HBV) cohorts is essential to address this issue. Despite its aggressive nature, effective HDV therapies have remained elusive for over four decades. Recent Findings Advances in understanding HDV's biology and clinical behavior offer potential therapeutic breakthroughs, fostering optimism. As insights grow, effective and targeted therapies are being developed to improve HDV management. Summary This review delves into HDV's intricate structure and biology, highlighting formidable hurdles in antiviral development. It emphasizes the importance of widespread screening, exploring noninvasive diagnostics, and examining current and emerging innovative therapeutic strategies. Moreover, the review explores models for monitoring treatment response. In essence, this review simplifies the complexities of effectively combating HDV.
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Affiliation(s)
- Harish Gopalakrishna
- Liver Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Maria Mironova
- Liver Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Harel Dahari
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Christopher Koh
- Liver Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Theo Heller
- Liver Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
- Translational Hepatology Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 10 Center Drive, Building 10, Room 4-5722, Bethesda, MD 20892-1800, USA
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Salpini R, Piermatteo L, Torre G, D'Anna S, Khan S, Duca L, Bertoli A, La Frazia S, Malagnino V, Teti E, Iannetta M, Paba P, Ciotti M, Lenci I, Francioso S, Paquazzi C, Lichtner M, Mastroianni C, Santopaolo F, De Sanctis G, Pellicelli A, Galati G, Moretti A, Casinelli K, Caterini L, Iapadre N, Parruti G, Vecchiet I, Paoloni M, Marignani M, Ceccherini-Silberstein F, Baiocchi L, Grelli S, Sarmati L, Svicher V. Prevalence of hepatitis D virus infection in Central Italy has remained stable across the last 2 decades with dominance of subgenotypes 1 and characterized by elevated viral replication. Int J Infect Dis 2024; 138:1-9. [PMID: 37944585 DOI: 10.1016/j.ijid.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES Here we investigate Hepatitis D virus (HDV)-prevalence in Italy and its fluctuations over time and we provide an extensive characterization of HDV-infected patients. METHODS The rate of HDV seroprevalence and HDV chronicity was assessed in 1579 hepatitis B surface antigen (HBsAg)+ patients collected from 2005 to 2022 in Central Italy. RESULTS In total, 45.3% of HBsAg+ patients received HDV screening with an increasing temporal trend: 15.6% (2005-2010), 45.0% (2011-2014), 49.4% (2015-2018), 71.8% (2019-2022). By multivariable model, factors correlated with the lack of HDV screening were alanine-aminotransferase (ALT) less than two times of upper limit of normality (<2ULN) and previous time windows (P <0.002). Furthermore, 13.4% of HDV-screened patients resulted anti-HDV+ with a stable temporal trend. Among them, 80.8% had detectable HDV-ribonucleic acid (RNA) (median [IQR]:4.6 [3.6-5.6] log copies/ml) with altered ALT in 89.3% (median [IQR]:92 [62-177] U/L). Anti-HDV+ patients from Eastern/South-eastern Europe were younger than Italians (44 [37-54] vs 53 [47-62] years, P <0.0001), less frequently nucleos(t)ide analogs (NUC)-treated (58.5% vs 80%, P = 0.026) with higher HDV-RNA (4.8 [3.6-5.8] vs 3.9 [1.4-4.9] log copies/ml, P = 0.016) and HBsAg (9461 [4159-24,532] vs 4447 [737-13,336] IU/ml, P = 0.032). Phylogenetic analysis revealed the circulation of HDV subgenotype 1e (47.4%) and -1c (52.6%). Notably, subgenotype 1e correlated with higher ALT than 1c (168 [89-190] vs 58 [54-88] U/l, P = 0.015) despite comparable HDV-RNA. CONCLUSIONS HDV-screening awareness is increasing over time even if some gaps persist to achieve HDV screening in all HBsAg+ patients. HDV prevalence in tertiary care centers tend to scarcely decline in native/non-native patients. Detection of subgenotypes, triggering variable inflammatory stimuli, supports the need to expand HDV molecular characterization.
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Affiliation(s)
- Romina Salpini
- Tor Vergata University, Department of Biology, Rome, Italy
| | | | - Giulia Torre
- Tor Vergata University, Department of Biology, Rome, Italy
| | - Stefano D'Anna
- Tor Vergata University, Department of Experimental Medicine, Rome, Italy
| | - Sohaib Khan
- Tor Vergata University, Department of Experimental Medicine, Rome, Italy
| | - Leonardo Duca
- Tor Vergata University, Department of Experimental Medicine, Rome, Italy
| | - Ada Bertoli
- Tor Vergata University, Department of Experimental Medicine, Rome, Italy; Tor Vergata University Hospital, Virology Unit, Rome, Italy
| | | | | | - Elisabetta Teti
- Tor Vergata University Hospital, Infectious Diseases Unit, Rome, Italy
| | - Marco Iannetta
- Tor Vergata University Hospital, Infectious Diseases Unit, Rome, Italy
| | - Pierpaolo Paba
- Tor Vergata University Hospital, Virology Unit, Rome, Italy
| | - Marco Ciotti
- Tor Vergata University Hospital, Virology Unit, Rome, Italy
| | - Ilaria Lenci
- Tor Vergata University Hospital, Hepatology Unit, Rome, Italy
| | | | | | - Miriam Lichtner
- La Sapienza University, Department of Public Health and Infectious Disease, Rome, Italy
| | - Claudio Mastroianni
- La Sapienza University, Department of Public Health and Infectious Disease, Rome, Italy
| | - Francesco Santopaolo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Internal Medicine and Gastroenterology-Hepatology Unit, Rome, Italy
| | | | | | - Giovanni Galati
- University Campus Bio-Medico, Internal Medicine and Hepatology Unit, Rome, Italy
| | | | - Katia Casinelli
- Spaziani Hospital, Infectious Disease Unit, Frosinone, Italy
| | | | - Nerio Iapadre
- San Salvatore Hospital, Infectious Diseases Unit, L'Aquila, Italy
| | - Giustino Parruti
- Pescara General Hospital, Infectious Disesases Unit, Pescara, Italy
| | - Iacopo Vecchiet
- University "G. d'Annunzio" Chieti-Pescara, Clinic of Infectious Diseases, Department of Medicine and Science of Aging, Chieti, Italy
| | - Maurizio Paoloni
- Avezzano General Hospital, Infectious Diseases Unit, Avezzano, Italy
| | - Massimo Marignani
- Regina Apostolorum Hospital, Department of Gastroenterology and Hepatology, Albano Laziale, Italy
| | | | | | - Sandro Grelli
- Tor Vergata University Hospital, Virology Unit, Rome, Italy
| | - Loredana Sarmati
- Tor Vergata University Hospital, Infectious Diseases Unit, Rome, Italy
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Ghany MG, Buti M, Lampertico P, Lee HM. Guidance on treatment endpoints and study design for clinical trials aiming to achieve cure in chronic hepatitis B and D: Report from the 2022 AASLD-EASL HBV-HDV Treatment Endpoints Conference. J Hepatol 2023; 79:1254-1269. [PMID: 37377088 DOI: 10.1016/j.jhep.2023.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/14/2023] [Indexed: 06/29/2023]
Abstract
Representatives from academia, industry, regulatory agencies, and patient advocacy groups convened under the American Association for the Study of Liver Diseases (AASLD) and the European Association for the Study of the Liver (EASL) in June 2022 with the primary goal of achieving consensus on chronic HBV and HDV treatment endpoints to guide clinical trials aiming to "cure" HBV and HDV. Conference participants reached an agreement on some key points. The preferred primary endpoint for phase II/III trials evaluating finite treatments for chronic hepatitis B (CHB) is a "functional" cure, defined as sustained HBsAg loss and HBV DNA less than the lower limit of quantitation (LLOQ) 24 weeks off-treatment. An alternate endpoint would be "partial cure" defined as sustained HBsAg level <100 IU/mL and HBV DNA
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Affiliation(s)
- Marc G Ghany
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.
| | - Maria Buti
- Liver Unit, Vall d'Hebron University Hospital and CIBEREHD del Instituto Carlos III, Barcelona, Spain
| | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, Milan, Italy; CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy
| | - Hannah M Lee
- Department of Gastroenterology, Hepatology and Nutrition, Stravitz Sanyal Institute for Liver Disease and Metabolic Health, Virginia Commonwealth University, Richmond, Virginia, USA
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Papatheodoridis G, Mimidis K, Manolakopoulos S, Triantos C, Vlachogiannakos I, Veretanos C, Deutsch M, Karatapanis S, Goulis I, Elefsiniotis I, Cholongitas E, Sevastianos V, Christodoulou D, Samonakis D, Manesis E, Kapatais A, Papadopoulos N, Ioannidou P, Germanidis G, Giannoulis G, Lakiotaki D, Kogias D, Kranidioti Η, Zisimopoulos K, Mela M, Kontos G, Fytili P, Manolaka C, Agorastou P, Pantzios SI, Papatheodoridi M, Karagiannakis D, Geladari E, Psychos N, Zachou K, Chalkidou A, Spanoudaki A, Thomopoulos K, Dalekos G. HERACLIS-HDV cohort for the factors of underdiagnosis and prevalence of hepatitis D virus infection in HBsAg-positive patients. Liver Int 2023; 43:1879-1889. [PMID: 37288712 DOI: 10.1111/liv.15638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/07/2023] [Accepted: 05/26/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND AIMS Hepatitis D virus (HDV) underdiagnosis remains common. We assessed the HDV screening and prevalence rates in HBsAg-positive patients seen at tertiary liver centres throughout Greece as well as factors affecting HDV diagnosis. METHODS All adult HBsAg-positive patients seen within the last 5 years were included. Non-screened patients who visited or could be recalled to the clinics over a 6-month period were prospectively tested for anti-HDV. RESULTS Of 5079 HBsAg-positive patients, 53% had anti-HDV screening (41% before and 12% after study initiation). Pre-study (8%-88%) and total screening rates (14%-100%) varied widely among centres. Screening rates were associated with older age, known risk group, elevated ALT, centre location and size and period of first visit. Anti-HDV prevalence was 5.8% without significant difference in patients screened before (6.1%) or after study initiation (4.7%, p = 0.240). Anti-HDV positivity was associated with younger age, parenteral drug use, born abroad, advanced liver disease and centre location. Overall, HDV RNA detectability rate was 71.6% being more frequent in anti-HDV-positive patients with elevated ALT, advanced liver disease and hepatitis B therapy. CONCLUSIONS Anti-HDV screening rates and recall capabilities vary widely among Greek liver clinics being higher in HBsAg-positive patients of known risk group with active/advanced liver disease seen at smaller centres, while non-medical factors are also important. Anti-HDV prevalence varies throughout Greece being higher in patients born abroad with younger age, parenteral drug use and advanced liver disease. Viremia is more frequently but not exclusively detected in anti-HDV-positive patients with elevated ALT and advanced liver disease.
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Affiliation(s)
- George Papatheodoridis
- Department of Gastroenterology, General Hospital of Athens "Laiko", Medical School of National & Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Mimidis
- First Department of Internal Medicine, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Spilios Manolakopoulos
- Second Department of Internal Medicine, General Hospital of Athens "Hippokratio", Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Triantos
- Gastroenterology Clinic, University General Hospital of Patras, Patras, Greece
| | - Ioannis Vlachogiannakos
- Department of Gastroenterology, General Hospital of Athens "Laiko", Medical School of National & Kapodistrian University of Athens, Athens, Greece
| | - Christos Veretanos
- Fourth Internal Medicine and Gastroenterology Department, General Hospital of Athens "Evangelismos", Athens, Greece
| | - Melanie Deutsch
- Second Department of Internal Medicine, General Hospital of Athens "Hippokratio", Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | | | - Ioannis Goulis
- Fourth Department of Internal Medicine, General Hospital of Thessaloniki "Hippokratio", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Elefsiniotis
- Department of Internal Medicine, General and Oncology Hospital of Kifisia "Agioi Anargyroi", Athens, Greece
| | - Evangelos Cholongitas
- Department of Gastroenterology, General Hospital of Athens "Laiko", Medical School of National & Kapodistrian University of Athens, Athens, Greece
| | - Vassilios Sevastianos
- Fourth Internal Medicine and Gastroenterology Department, General Hospital of Athens "Evangelismos", Athens, Greece
| | | | - Dimitrios Samonakis
- Department of Gastroenterology, University General Hospital of Heraklion Crete, Heraclion, Greece
| | | | - Andreas Kapatais
- Department of Internal Medicine, General Hospital Nikaia-Piraeus "Agios Panteleimon" & General Hospital of Western Attica "Agia Varvara", Piraeus, Greece
| | - Nikolaos Papadopoulos
- Second Department of Internal Medicine, General Hospital of Athens "Hippokratio", Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiota Ioannidou
- Department of Gastroenterology, General Hospital of Athens "Laiko", Medical School of National & Kapodistrian University of Athens, Athens, Greece
| | - Georgios Germanidis
- First Department of Internal Medicine, University General Hospital of Thessaloniki "AHEPA", Thessaloniki, Greece
| | - George Giannoulis
- Department of Internal Medicine, General University Hospital of Larissa, Larissa, Greece
| | - Dimitra Lakiotaki
- Department of Gastroenterology, General Hospital of Athens "Laiko", Medical School of National & Kapodistrian University of Athens, Athens, Greece
| | - Dionysios Kogias
- First Department of Internal Medicine, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Ηarikleia Kranidioti
- Second Department of Internal Medicine, General Hospital of Athens "Hippokratio", Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | | | - Maria Mela
- Fourth Internal Medicine and Gastroenterology Department, General Hospital of Athens "Evangelismos", Athens, Greece
| | - George Kontos
- Second Department of Internal Medicine, General Hospital of Athens "Hippokratio", Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevi Fytili
- Department of Gastroenterology, General Hospital of Athens "Laiko", Medical School of National & Kapodistrian University of Athens, Athens, Greece
| | | | - Polyxeni Agorastou
- Fourth Department of Internal Medicine, General Hospital of Thessaloniki "Hippokratio", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Spyridon I Pantzios
- Department of Internal Medicine, General and Oncology Hospital of Kifisia "Agioi Anargyroi", Athens, Greece
| | - Margarita Papatheodoridi
- Department of Gastroenterology, General Hospital of Athens "Laiko", Medical School of National & Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Karagiannakis
- Department of Gastroenterology, General Hospital of Athens "Laiko", Medical School of National & Kapodistrian University of Athens, Athens, Greece
| | - Eleni Geladari
- Fourth Internal Medicine and Gastroenterology Department, General Hospital of Athens "Evangelismos", Athens, Greece
| | - Nikolaos Psychos
- Department of Gastroenterology, University General Hospital of Ioannina, Ioannina, Greece
| | - Kalliopi Zachou
- Department of Internal Medicine, General University Hospital of Larissa, Larissa, Greece
| | - Anna Chalkidou
- First Department of Internal Medicine, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Anastasia Spanoudaki
- Second Department of Internal Medicine, General Hospital of Athens "Hippokratio", Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | | | - George Dalekos
- Department of Internal Medicine, General University Hospital of Larissa, Larissa, Greece
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8
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Wedemeyer H, Leus M, Battersby TR, Glenn J, Gordien E, Kamili S, Kapoor H, Kessler HH, Lenz O, Lütgehetmann M, Mixson-Hayden T, Simon CO, Thomson M, Westman G, Miller V, Terrault N, Lampertico P. HDV RNA assays: Performance characteristics, clinical utility, and challenges. Hepatology 2023:01515467-990000000-00551. [PMID: 37640384 PMCID: PMC11289715 DOI: 10.1097/hep.0000000000000584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/15/2023] [Indexed: 08/31/2023]
Abstract
Coinfection with HBV and HDV results in hepatitis D, the most severe form of chronic viral hepatitis, frequently leading to liver decompensation and HCC. Pegylated interferon alpha, the only treatment option for chronic hepatitis D for many years, has limited efficacy. New treatments are in advanced clinical development, with one recent approval. Diagnosis and antiviral treatment response monitoring are based on detection and quantification of HDV RNA. However, the development of reliable HDV RNA assays is challenged by viral heterogeneity (at least 8 different genotypes and several subgenotypes), intrahost viral diversity, rapid viral evolution, and distinct secondary structure features of HDV RNA. Different RNA extraction methodologies, primer/probe design for nucleic acid tests, lack of automation, and overall dearth of standardization across testing laboratories contribute to substantial variability in performance characteristics of research-based and commercial HDV RNA assays. A World Health Organization (WHO) standard for HDV RNA, available for about 10 years, has been used by many laboratories to determine the limit of detection of their assays and facilitates comparisons of RNA levels across study centers. Here we review challenges for robust pan genotype HDV RNA quantification, discuss particular clinical needs and the importance of reliable HDV RNA quantification in the context of drug development and patient monitoring. We summarize distinct technical features and performance characteristics of available HDV RNA assays. Finally, we provide considerations for the use of HDV RNA assays in the context of drug development and patient monitoring.
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Affiliation(s)
- Heiner Wedemeyer
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
- Excellence Cluster RESIST, Hannover Medical School, Hannover, Germany
- D-SOLVE: EU-funded Network on Individualized Management of Hepatitis D
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Braunschweig, Germany
| | - Mitchell Leus
- Forum for Collaborative Research, School of Public Health, University of California, Berkeley, Washington DC Campus, Washington, District of Columbia, USA
| | | | - Jeffrey Glenn
- Departments of Medicine (Division of Gastroenterology and Hepatology) and Microbiology & Immunology, Stanford University School of Medicine, Stanford, California, USA
| | - Emmanuel Gordien
- Laboratoire de microbiologie clinique, Centre National de Référence pour les virus des hépatites B, C et Delta, Hôpital Avicenne Assistance Publique – Hôpitaux de Paris, Bobigny, France
| | - Saleem Kamili
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hema Kapoor
- Ex Quest Diagnostics, HK Healthcare Consultant LLC, Secaucus, New Jersey, USA
| | - Harald H. Kessler
- Diagnostic and Research Center for Molecular Biomedicine, Medical University of Graz, Graz, Austria
| | - Oliver Lenz
- Clinical Microbiology and Immunology, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Marc Lütgehetmann
- Institute for Microbiology, Virology and Hygiene, University Medical Center Hamburg Eppendorf (UKE), Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg, Lübeck, Kiel, Germany
| | - Tonya Mixson-Hayden
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christian O. Simon
- Clinical Development and Medical Affairs, Roche Diagnostics Solutions, Rotkreuz, Switzerland
| | - Michael Thomson
- Division of Antivirals, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Gabriel Westman
- Swedish Medical Products Agency, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Veronica Miller
- Forum for Collaborative Research, School of Public Health, University of California, Berkeley, Washington DC Campus, Washington, District of Columbia, USA
| | - Norah Terrault
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, CRC “A. M. and A. Migliavacca” Center for Liver Disease, University of Milan, Milan, Italy
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9
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Abbas Z, Abbas M. An Insight Into the Factors Affecting the Prevalence and Natural History of Hepatitis D. Cureus 2023; 15:e43362. [PMID: 37593072 PMCID: PMC10427805 DOI: 10.7759/cureus.43362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 08/19/2023] Open
Abstract
Epidemiological studies and recent metanalyses addressing hepatitis D have reported a wide variation in the prevalence of the disease. Between 4.5% to 15% of all hepatitis B surface antigen (HBsAg) positive patients are thought to harbor the hepatitis D virus. The emergent variation in prevalence can be attributed to several factors. Unsurprisingly, published literature shows that the prevalence of the disease is higher in areas where aggregate viral hepatitis infections are endemic and amongst groups with high-risk practices facilitating the horizontal transfer. Meanwhile, the natural history of the disease is influenced by the genotype of the virus, the hepatitis D virus (HDV) RNA levels, HBV-HDV codominance, HBsAg titers, HBV genotype, nutritional status, HIV co-infection, and prior treatment. Together these factors contribute to the accelerated development of fibrosis and the increased risk of hepatocellular carcinoma. Superinfection with genotype 1 results in rapid progression to cirrhosis with lower rates of remission. Genotype 3 follows an aggressive course but shows a good response to interferon therapy. Other genotypes have better outcomes. The course of the disease leading to these outcomes can be tracked by HDV-specific models integrating clinical surrogate markers and epidemiological factors such as age, region, alanine aminotransferase (ALT), gamma-glutamyl transferase, albumin, platelets and cholinesterase, and liver stiffness.
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Affiliation(s)
- Zaigham Abbas
- Gastroenterology and Hepatology, Dr. Ziauddin University Hospital, Karachi, PAK
| | - Minaam Abbas
- Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, GBR
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10
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Pearlman B. Hepatitis Delta Infection: A Clinical Review. Semin Liver Dis 2023; 43:293-304. [PMID: 37473778 PMCID: PMC10620035 DOI: 10.1055/a-2133-8614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
First discovered over 40 years ago, the hepatitis delta virus (HDV) is a unique RNA virus, requiring hepatitis B virus (HBV) antigens for its assembly, replication, and transmission. HBV and HDV can be acquired at the same time (coinfection) or HDV infection can occur in persons with chronic HBV (superinfection). Screening guidelines for HDV are inconsistent. While some guidelines recommend universal screening for all people with HBV, others recommend risk-based screening. Estimates of the global HDV prevalence range from 4.5 to 14.6% among persons with HBV; thus, there may be up to 72 million individuals with HDV worldwide. HDV is the most severe form of viral hepatitis. Compared to HBV monoinfection, HDV coinfection increases the risk of cirrhosis, hepatocellular carcinoma, hepatic decompensation, mortality, and necessity for liver transplant. Despite the severity of HDV, there are few treatment options. Pegylated interferon (off-label use) has long been the only available treatment, although bulevirtide is conditionally approved in some European countries. There are many potential treatments in development, but as yet, there are few effective and safe therapies for HDV infection. In conclusion, given the severity of HDV disease and the paucity of treatments, there is a great unmet need for HDV therapies.
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Affiliation(s)
- Brian Pearlman
- Department of Internal Medicine, Wellstar Atlanta Medical Center, Medical College of Georgia, Emory School of Medicine, Atlanta, Georgia
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11
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Brunetto MR, Ricco G, Negro F, Wedemeyer H, Yurdaydin C, Asselah T, Papatheodoridis G, Gheorghe L, Agarwal K, Farci P, Buti M. EASL Clinical Practice Guidelines on hepatitis delta virus. J Hepatol 2023; 79:433-460. [PMID: 37364791 DOI: 10.1016/j.jhep.2023.05.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 06/28/2023]
Abstract
Hepatitis D virus (HDV) is a defective virus that requires the hepatitis B virus to complete its life cycle and cause liver damage in humans. HDV is responsible for rare acute and chronic liver diseases and is considered the most aggressive hepatitis virus. Acute infection can cause acute liver failure, while persistent infection typically causes a severe form of chronic hepatitis which is associated with rapid and frequent progression to cirrhosis and its end-stage complications, hepatic decompensation and hepatocellular carcinoma. Major diagnostic and therapeutic innovations prompted the EASL Governing Board to commission specific Clinical Practice Guidelines on the identification, virologic and clinical characterisation, prognostic assessment, and appropriate clinical and therapeutic management of HDV-infected individuals.
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12
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Affiliation(s)
- Tarik Asselah
- From Université de Paris-Cité, Hôpital Beaujon, Department of Hepatology, Assistance Publique-Hôpitaux de Paris, and INSERM Unité Mixte de Recherche 1149, Clichy, France (T.A.); and the Department of Medical Sciences, University of Turin, Turin, Italy (M.R.)
| | - Mario Rizzetto
- From Université de Paris-Cité, Hôpital Beaujon, Department of Hepatology, Assistance Publique-Hôpitaux de Paris, and INSERM Unité Mixte de Recherche 1149, Clichy, France (T.A.); and the Department of Medical Sciences, University of Turin, Turin, Italy (M.R.)
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13
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Mangia A, Squillante MM, Fraticelli F, Cavorsi MC, Paroni G, Zaffarano L, Piazzolla AV. HDV RNA Levels and Progression of Hepatitis Delta Infection: A 14 Year Follow Up Experience in Italy. Cells 2023; 12:1413. [PMID: 37408247 DOI: 10.3390/cells12101413] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Identification of outcome predictors is one of the unmet needs in chronic HDV infection. Until recently, no reliable quantitative assays for HDV RNA were available. AIMS To evaluate the impact of baseline viremia on natural history of HDV infection in a cohort of patients whose serum samples were stored at their first visit 15 years ago. METHODS Quantitative HBsAg, HBeAg, HBeAb, HBV DNA, HDV RNA, genotypes, and liver disease severity were assessed at baseline. Patients who were no longer on active follow-up were recalled and re-evaluated in August 2022. RESULTS The majority of patients were male (64.9%); the median age was 50.1 years; and all patients were Italian, with only three born in Romania. All were HBeAg negative with HBV genotype D infection. Patients were subdivided three groups: 23 were in active follow-up (Group 1), 21 were recalled due to no longer being in follow-up (Group 2), and 11 died (Group 3). Liver cirrhosis was diagnosed in 28 subjects at the first visit; 39.3% of diagnosed patients were in Group 3, 32.1% were in Group 1 and 28.6% were in Group 2 (p = 0.001). Baseline HBV DNA IU/mL Log10 were 1.6 (1.0-5.9) in Group 1, 1.3 (1.0-4.5) in Group 2, and 4.1 (1.5-4.5) in Group 3; median baseline HDV RNA Log10 levels were 4.1 (0.7-6.7) in Group 1, 3.2 (0.7-6.2) in Group 2, and 5.2 (0.7-6.7) in Group 3, resulting significantly higher rates among patients in Group 3 compared to the other groups (p = 0.038). Eighteen patients in Group 2, as compared to 7 in Group 1, had undetectable HDV RNA at the follow-up evaluation (p = 0.001). CONCLUSIONS HDV chronic infection is a heterogeneous disease. It may not only progress but also improve over time in patients, who eventually become HDV RNA-undetectable. HDV RNA levels may help identify the subgroup of patients with less progressive liver disease.
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Affiliation(s)
- Alessandra Mangia
- Liver Unit, IRCCS Fondazione "Casa Sollievo della Sofferenza", 71013 San Giovanni Rotondo, Italy
| | | | - Filippo Fraticelli
- Liver Unit, IRCCS Fondazione "Casa Sollievo della Sofferenza", 71013 San Giovanni Rotondo, Italy
| | - Maria Chiara Cavorsi
- Liver Unit, IRCCS Fondazione "Casa Sollievo della Sofferenza", 71013 San Giovanni Rotondo, Italy
| | - Giulia Paroni
- Blood Bank, IRCCS Fondazione "Casa Sollievo della Sofferenza", 71013 San Giovanni Rotondo, Italy
| | - Lucia Zaffarano
- Blood Bank, IRCCS Fondazione "Casa Sollievo della Sofferenza", 71013 San Giovanni Rotondo, Italy
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14
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Kalkan Ç, Yılmaz Y, Erdoğan BD, Savaş B, Yurdcu E, Çalışkan A, Keskin O, Gencdal G, Zeybel M, Törüner M, Bozdayi AM, Idilman R, Yurdaydin C. Non-invasive fibrosis markers for assessment of liver fibrosis in chronic hepatitis delta. J Viral Hepat 2023; 30:406-416. [PMID: 36651603 DOI: 10.1111/jvh.13806] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023]
Abstract
Assessment of liver fibrosis by non-invasive means is clinically important. Studies in chronic hepatitis delta (CHD) are scarce. We evaluated the performance of eight serum fibrosis markers [fibrosis-4 score (FIB-4), aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR), age-platelet index (API), AST-to platelet-ratio-index (APRI), Goteborg University Cirrhosis Index (GUCI), Lok index, cirrhosis discriminant score (CDS) and Hui score] in CHD and chronic hepatitis B (CHB). Liver stiffness was assessed by transient elastography (TE) in CHD. The ability of fibrosis markers to detect significant fibrosis and cirrhosis were evaluated in 202 CHB and 108 CHD patients using published and new cut-offs through receiver operating characteristics (ROC) analysis. The latter was also applied to obtain cut-offs for TE. APRI, Fib-4, API and Hui score were assessed for significant fibrosis, and APRI, GUCI, Lok index, CDS and AAR for cirrhosis determination. Fibrosis markers displayed weak performance in CHB for significant fibrosis with area under ROC (AUROC) curves between 0.62 and 0.71. They did slightly better for CHD. TE displayed an AUROC of 0.92 and performed better than serum fibrosis markers (p < 0.05 for fibrosis markers). For cirrhosis determination, CDS and Lok Index displayed an AUROC of 088 and 0.89 in CHB and GUCI, Lok index and APRI displayed AUROCs around 0.90 in CHD. TE displayed the best AUROC (0.95). Hence TE is superior to serum fibrosis markers for diagnosing significant liver fibrosis and cirrhosis. GUCI, Lok index and APRI displayed a reasonable performance in CHD, which needs further confirmation.
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Affiliation(s)
- Çağdaş Kalkan
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Yusufcan Yılmaz
- Department of Internal Medicine, Ankara University Medical School, Ankara, Turkey
| | | | - Berna Savaş
- Department of Pathology, Ankara University Medical School, Ankara, Turkey
| | - Esra Yurdcu
- Hepatology Institute, Ankara University, Ankara, Turkey
| | - Aysun Çalışkan
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Onur Keskin
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Genco Gencdal
- Department of Gastroenterology & Hepatology, Koç University Medical School, Istanbul, Turkey
| | - Müjdat Zeybel
- Department of Gastroenterology & Hepatology, Koç University Medical School, Istanbul, Turkey.,NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust & University of Nottingham, Nottingham, UK
| | - Murat Törüner
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | | | - Ramazan Idilman
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Cihan Yurdaydin
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey.,Department of Gastroenterology & Hepatology, Koç University Medical School, Istanbul, Turkey
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15
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Koffas A, Mak LY, Kennedy PTF. Hepatitis delta virus: Disease assessment and stratification. J Viral Hepat 2022; 30 Suppl 1:11-20. [PMID: 36458851 DOI: 10.1111/jvh.13777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/26/2022] [Indexed: 12/09/2022]
Abstract
Hepatitis D virus (HDV) causes one of the most severe forms of hepatitis in people with chronic hepatitis B (CHB) infection. Timely and accurate assessment of hepatitis delta virus (HDV) and disease stratification is mandatory for thorough pre-therapeutic evaluation for prioritizing treatment and outcome prediction. Viral biomarkers associated with HDV and hepatitis B virus (HBV) are crucial to aid in diagnosis, and monitoring of serum viral nucleic acids for both viruses is recommended. Liver biopsy remains the gold standard for staging of liver fibrosis and grading of histological activity and should remain central for diagnostic purposes, but is also of importance for research to enhance our understanding of HDV. The emergence of novel non-invasive tests for the assessment of liver fibrosis in HDV patients coupled with the well-recognized potential complications of liver biopsy has resulted in reduced utility of liver biopsy in clinical practice. Preliminary data suggest that these emerging non-invasive modalities appear to be reliable, and their use is supported, similar to other viral hepatitis. Nevertheless, further validation is required before their widespread adoption into clinical practice.
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Affiliation(s)
- Apostolos Koffas
- Barts Liver Centre, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Lung-Yi Mak
- Barts Liver Centre, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Department of Medicine, Queen Mary Hospital, School of Clinical Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Patrick T F Kennedy
- Barts Liver Centre, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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16
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Salpini R, D'Anna S, Piermatteo L, Svicher V. Novel concepts on mechanisms underlying Hepatitis Delta virus persistence and related pathogenesis. J Viral Hepat 2022; 29:1038-1047. [PMID: 36256499 DOI: 10.1111/jvh.13755] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/07/2022] [Indexed: 12/09/2022]
Abstract
Hepatitis Delta virus is the smallest known human virus, exploiting the HBV surface proteins (HBsAg) for the release of its progeny and de novo entry into hepatocytes. Ever growing evidence have highlighted the existence of multiple mechanisms underlying HDV persistence including integrated HBV-DNA as a source of HBsAg production and the capability of the HDV genome to propagate through cell proliferation, thus supporting a potential HDV persistence even in the absence of HBV. Chronic HDV-infection causes the most severe form of viral hepatitis, leading to the development of cirrhosis in 15% of cases within 1-2 years and in 50%-60% of cases within 5-10 years. The rates of hepatocellular carcinoma and hepatic decompensation are also 2-3-fold higher than for HBV mono-infection. There is the evidence that persistent viral replication plays a key role in triggering liver injury, suggesting the existence of direct viral cytopathic properties that can modulate, synergistically with immune-responses, the progression towards end-stage liver diseases. All these aspects can be further exacerbated by the extraordinary degree of viral genetic variability that can promote HDV evasion from immune responses and has enabled viral differentiation into genotypes and subgenotypes with potential different pathobiological properties. In this light, this review aims at providing comprehensive insights of mechanisms (with a focus on virological factors) underlying HDV persistence and pathogenesis, critical in shaping the clinical outcome of the infection. Dissecting these mechanisms is pivotal to optimize therapeutic strategies aimed at fully counteracting this fascinating and fearsome virus.
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Affiliation(s)
- Romina Salpini
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Stefano D'Anna
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Lorenzo Piermatteo
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.,Department of Biology, University of Rome Tor Vergata, Rome, Italy
| | - Valentina Svicher
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.,Department of Biology, University of Rome Tor Vergata, Rome, Italy
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17
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Riveiro-Barciela M, Palom A, Buti M. New actors come into play against hepatitis delta. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS : ORGANO OFICIAL DE LA SOCIEDAD ESPANOLA DE PATOLOGIA DIGESTIVA 2022; 114:702-704. [PMID: 36043543 DOI: 10.17235/reed.2022.9050/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Currently chronic hepatitis delta (CHD) represents the most severe form of chronic viral hepatitis. The risk of developing cirrhosis, hepatocellular carcinoma (HCC) and decompensated liver disease is 2-3 times greater in hepatitis delta virus (HDV) infection than in hepatitis B virus (HBV). For instance, in a study carried out in Italy including 299 CHD patients followed for 28 years, 82 (27%) developed cirrhosis, and among these, 46 (56%) developed HCC. The real number of subjects infected by HDV worldwide remains unknown due to the lack of information in many areas, though it has been suggested that the rate of HBsAg carriers co-infected by HDV may be situated between 4.5 and 18%.
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Affiliation(s)
- Mar Riveiro-Barciela
- Liver Unit. Internal Medicine Department, Hospital Universitary Vall d'Hebrón, España
| | - Adriana Palom
- Liver Unit. Internal Medicine Department, Hospital Universitari Vall d'Hebrón
| | - Maria Buti
- Liver Unit. Internal Medicine Department, Hospital Universitari Vall d´Hebron
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18
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Jachs M, Schwarz C, Panzer M, Binter T, Aberle SW, Hartl L, Dax K, Aigner E, Stättermayer AF, Munda P, Graziadei I, Holzmann H, Trauner M, Zoller H, Gschwantler M, Mandorfer M, Reiberger T, Ferenci P. Response-guided long-term treatment of chronic hepatitis D patients with bulevirtide-results of a "real world" study. Aliment Pharmacol Ther 2022; 56:144-154. [PMID: 35514008 PMCID: PMC9321570 DOI: 10.1111/apt.16945] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/21/2022] [Accepted: 04/10/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Bulevirtide (BLV) blocks the uptake of the hepatitis D virus (HDV) into hepatocytes via the sodium/bile acid cotransporter NTCP. BLV was conditionally approved by the EMA but real-life data on BLV efficacy are limited. METHODS Patients were treated with BLV monotherapy. Patients who did not achieve further decreases in HDV-RNA after 24 weeks were offered PEG-IFN as an add-on therapy in a response-guided manner. RESULTS Twenty-three patients (m: 10, f: 13; mean age: 47.9 years, cirrhosis: 16; median ALT: 71 IU/ml; median HDV-RNA: 2.1 × 105 copies/ml) started BLV monotherapy (2 mg/day: 22; 10 mg/day: 1). Twenty-two completed ≥24 weeks of treatment (24-137 weeks): Ten (45%) were classified as BLV responders at week 24. BLV was stopped in two patients with >6 months HDV-RNA undetectability, but both became HDV-RNA positive again. One patient was transplanted at week 25. One patient terminated treatment because of side effects at week 60. Ten patients are still on BLV monotherapy. Adding PEG-IFN in eight patients induced an HDV-RNA decrease in all (1.29 ± 0.19 [SD] log within 12 weeks). HDV-RNA decreased by >2log or became undetectable in 45%(10/22), 55%(11/20), 65% (13/20) and 69% (9/13); and ALT levels normalised in 64% (14/22), 85% (17/20), 90% (18/20) and in 92% (12/13) patients at weeks 24, 36, 48 and 60, respectively. Portal pressure decreased in 40% (2/5) of patients undergoing repeated measurement under BLV therapy. CONCLUSION Long-term BLV monotherapy is safe and effectively decreases HDV-RNA and ALT-even in patients with cirrhosis. The optimal duration of BLV treatment alone or in combination with PEG-IFN remains to be established. An algorithm for a response-guided BLV treatment approach is proposed.
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Affiliation(s)
- Mathias Jachs
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.,Rare Liver Disease (RALID) Center of the European Reference Network for Rare Hepatological Diseases (ERN RARE-LIVER), Medical University Vienna, Vienna, Austria
| | | | | | - Teresa Binter
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.,Rare Liver Disease (RALID) Center of the European Reference Network for Rare Hepatological Diseases (ERN RARE-LIVER), Medical University Vienna, Vienna, Austria
| | - Stephan W Aberle
- Center of Clinical Virology, Medical University of Vienna, Vienna, Austria
| | - Lukas Hartl
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.,Rare Liver Disease (RALID) Center of the European Reference Network for Rare Hepatological Diseases (ERN RARE-LIVER), Medical University Vienna, Vienna, Austria
| | | | - Elmar Aigner
- SALK und Paracelsus Medical University, Salzburg, Austria
| | - Albert F Stättermayer
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.,Rare Liver Disease (RALID) Center of the European Reference Network for Rare Hepatological Diseases (ERN RARE-LIVER), Medical University Vienna, Vienna, Austria
| | - Petra Munda
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Ivo Graziadei
- Department of Medicine, Landeskrankenhaus Hall, Austria
| | | | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.,Rare Liver Disease (RALID) Center of the European Reference Network for Rare Hepatological Diseases (ERN RARE-LIVER), Medical University Vienna, Vienna, Austria
| | - Heinz Zoller
- Medical University of Innsbruck, Innsbruck, Austria
| | | | - Mattias Mandorfer
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.,Rare Liver Disease (RALID) Center of the European Reference Network for Rare Hepatological Diseases (ERN RARE-LIVER), Medical University Vienna, Vienna, Austria
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.,Rare Liver Disease (RALID) Center of the European Reference Network for Rare Hepatological Diseases (ERN RARE-LIVER), Medical University Vienna, Vienna, Austria
| | - Peter Ferenci
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
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19
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Corrigendum. Aliment Pharmacol Ther 2022; 55:1473. [PMID: 35538359 DOI: 10.1111/apt.16933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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20
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Cortese MF, Riveiro-Barciela M, Tabernero D, Rodriguez-Algarra F, Palom A, Sopena S, Rando-Segura A, Roade L, Kuchta A, Ferrer-Costa R, Quer J, Pacin B, Vila M, Casillas R, Garcia-Garcia S, Esteban R, Pumarola T, Buti M, Rodriguez-Frias F. Standardized Hepatitis B Virus RNA Quantification in Untreated and Treated Chronic Patients: a Promising Marker of Infection Follow-Up. Microbiol Spectr 2022; 10:e0214921. [PMID: 35377229 PMCID: PMC9045303 DOI: 10.1128/spectrum.02149-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/11/2022] [Indexed: 02/07/2023] Open
Abstract
The measurement and interpretation of HBV DNA and RNA levels in HBV infected patients treated with antiviral therapy supports the objective of HBV disease management. Here, we quantified circulating HBV RNA through a standardized and sensitive assay in follow-up samples from both naive and treated patients as a marker of infection evolution. HBV DNA (HBV DNA for use in Cobas 6800/8800 Automated Roche Molecular Systems), RNA (Roche HBV RNA Investigational Assay for use in the Cobas 6800/8800; Roche), HBeAg and HBsAg (Elycsys HBsAg chemiluminescence immunoassay by Cobas 8000; Roche), and core-related antigen (Lumipulse G chemiluminescence assay; Fujirebio) levels were measured in cohorts of untreated or nucleos(t)ide treated, HBV-infected subjects in an outpatient hospital setting. HBV DNA levels in untreated people were 3.6 log10 higher than corresponding RNA levels and were stable over 5 years of observation. While only five of 52 treated patients had DNA levels below the lower limit of quantification (10 IU/mL) at the end of follow-up, 13 had HBV RNA levels persistently above this limit, including eight with undetectable DNA. In samples with undetectable core-related antigen we observed a median HBsAg titer 2.7-fold higher than in samples with undetectable RNA (adjusted P = 0.012). Detectable HBV RNA with undetectable HBV DNA was a negative predictor of HBsAg decrease to a level ≤100 IU/mL (P = 0.03). In naive patients the difference between HBV DNA and RNA was higher than previously reported. HBV RNA rapidly decreased during treatment. However, in some cases, it was detectable even after years of effective therapy, being a negative predictor of HBsAg decrease. The investigational RNA assay for use on the Cobas 6800/8800 instruments is a sensitive and standardized method that could be applied in general management of HBV infection. IMPORTANCE This study focused on the quantification of circulating HBV RNA by using a standardized and sensitive assay. Thanks to this system we observed a higher difference between circulating HBV DNA and RNA than previously reported. In treated patients, HBV RNA decreased together with DNA, although some patients presented detectable levels even after years of successful antiviral treatment, suggesting a persistent viral transcription. Of note, the detection of viral RNA when HBV DNA is undetectable was a negative predictor of HBsAg decrease to a level ≤100 IU/mL. This assay could be extremely helpful in HBV patients management to study viral transcription and to identify those treated patients that may achieve sustained viral suppression.
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Affiliation(s)
- Maria Francesca Cortese
- Clinical Biochemestry, Vall D'hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Biochemistry and Microbiology, Liver Pathology Unit, Vall D'hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro De Investigación Biomédica En Red, Enfermedades Hepáticas y Digestvas (CIBERehd), Instituto De Salud Carlos III, Madrid, Spain
| | - Mar Riveiro-Barciela
- Centro De Investigación Biomédica En Red, Enfermedades Hepáticas y Digestvas (CIBERehd), Instituto De Salud Carlos III, Madrid, Spain
- Liver Unit, Internal Medicine Department, Vall D'hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Tabernero
- Biochemistry and Microbiology, Liver Pathology Unit, Vall D'hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro De Investigación Biomédica En Red, Enfermedades Hepáticas y Digestvas (CIBERehd), Instituto De Salud Carlos III, Madrid, Spain
| | - Francisco Rodriguez-Algarra
- The Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Adriana Palom
- Liver Unit, Internal Medicine Department, Vall D'hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sara Sopena
- Biochemistry and Microbiology, Liver Pathology Unit, Vall D'hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ariadna Rando-Segura
- Biochemistry and Microbiology, Liver Pathology Unit, Vall D'hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Virology Unit, Microbiology Department, Vall D'hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luisa Roade
- Liver Unit, Internal Medicine Department, Vall D'hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alison Kuchta
- Roche Molecular Systems, Inc., Pleasanton, California, USA
| | - Roser Ferrer-Costa
- Department of Biochemistry, Vall D'Hebron University Hospital, Barcelona, Spain
| | - Josep Quer
- Centro De Investigación Biomédica En Red, Enfermedades Hepáticas y Digestvas (CIBERehd), Instituto De Salud Carlos III, Madrid, Spain
- Digestive and Liver Disease, Vall D'hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Beatriz Pacin
- Clinical Biochemestry, Vall D'hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Biochemistry and Microbiology, Liver Pathology Unit, Vall D'hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro De Investigación Biomédica En Red, Enfermedades Hepáticas y Digestvas (CIBERehd), Instituto De Salud Carlos III, Madrid, Spain
| | - Marta Vila
- Clinical Biochemestry, Vall D'hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Biochemistry and Microbiology, Liver Pathology Unit, Vall D'hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rosario Casillas
- Clinical Biochemestry, Vall D'hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Biochemistry and Microbiology, Liver Pathology Unit, Vall D'hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Selene Garcia-Garcia
- Clinical Biochemestry, Vall D'hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Biochemistry and Microbiology, Liver Pathology Unit, Vall D'hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro De Investigación Biomédica En Red, Enfermedades Hepáticas y Digestvas (CIBERehd), Instituto De Salud Carlos III, Madrid, Spain
| | - Rafael Esteban
- Centro De Investigación Biomédica En Red, Enfermedades Hepáticas y Digestvas (CIBERehd), Instituto De Salud Carlos III, Madrid, Spain
- Liver Unit, Internal Medicine Department, Vall D'hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tomás Pumarola
- Virology Unit, Microbiology Department, Vall D'hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Maria Buti
- Centro De Investigación Biomédica En Red, Enfermedades Hepáticas y Digestvas (CIBERehd), Instituto De Salud Carlos III, Madrid, Spain
- Liver Unit, Internal Medicine Department, Vall D'hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francisco Rodriguez-Frias
- Clinical Biochemestry, Vall D'hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Biochemistry and Microbiology, Liver Pathology Unit, Vall D'hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro De Investigación Biomédica En Red, Enfermedades Hepáticas y Digestvas (CIBERehd), Instituto De Salud Carlos III, Madrid, Spain
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Usai C, Gill US, Riddell AC, Asselah T, Kennedy P. Review article: emerging insights into the immunopathology, clinical and therapeutic aspects of hepatitis delta virus. Aliment Pharmacol Ther 2022; 55:978-993. [PMID: 35292991 PMCID: PMC9314912 DOI: 10.1111/apt.16807] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/06/2021] [Accepted: 01/25/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hepatitis delta virus (HDV), which causes the most severe form of viral hepatitis, is an obligated hepatitis B (HBV) satellite virus that can either infect naïve subjects simultaneously with HBV (co-infection), or chronically infect HBV carriers (super-infection). An estimated 12 million people are infected by HDV worldwide. AIMS To summarise the most relevant aspects of the molecular biology of HDV, and to discuss the latest understanding of the induced pathology, interactions with the immune system, as well as both approved and investigational treatment options. METHODS References for this review were identified through searches of PubMed with the terms "HDV" "viral hepatitis" "co-infection" and "super-infection," published between 1980 and October 2021 RESULTS: The limited access to the HDV-infected liver has hampered the investigation of the intrahepatic compartment and our understanding of the mechanisms of HDV pathogenesis. In the absence of standardised and sensitive diagnostic tools, HDV is often underdiagnosed and owing to its strong dependence on host cellular factors, the development of direct antiviral agents has been challenging. New therapeutic agents targeting different steps of the viral cycle have recently been investigated, among which bulevirtide (which was conditionally approved by EMA in July 2020) and lonafarnib; both drugs having received orphan drug designation from both the EMA and FDA. CONCLUSIONS The HBV cure programme potentially offers a unique opportunity to enhance HDV treatment strategies. In addition, a more comprehensive analysis of the intrahepatic compartment is mandated to better understand any liver-confined interaction of HDV with the host immune system.
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Affiliation(s)
- Carla Usai
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK,Present address:
Unitat mixta d’Investigació IRTA‐UAB en Sanitat AnimalCentre de Recerca en Sanitat Animal (CReSA)Campus de la Universitat Autònoma de Barcelona (UAB)Bellaterra08193Spain
| | - Upkar S. Gill
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK,The Royal London HospitalBarts Health NHS TrustLondonUK
| | - Anna C. Riddell
- Division of Infection, Virology DepartmentBarts Health NHS TrustLondonUK
| | - Tarik Asselah
- Centre de recherche sur l'inflammation, Inserm U1149Université́ de ParisParisFrance,Department of Hepatology, AP‐HPHôpital BeaujonClichyFrance
| | - Patrick T. Kennedy
- Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK,The Royal London HospitalBarts Health NHS TrustLondonUK
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22
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Corrigenda. Aliment Pharmacol Ther 2021; 54:1508. [PMID: 34741332 DOI: 10.1111/apt.16671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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23
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Soriano V, Alvarez C, Edagwa B, de Mendoza C, Montoya N, Treviño A, Gendelman H. Ultra-long-acting (XLA) antivirals for chronic viral hepatitis. Int J Infect Dis 2021; 114:45-50. [PMID: 34728344 PMCID: PMC9204217 DOI: 10.1016/j.ijid.2021.10.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 12/16/2022] Open
Abstract
Viral hepatitis is among the top four causes of mortality globally, causing 1.4 million deaths each year, exceeding tuberculosis, malaria and human immunodeficiency virus. Hepatitis B and C are responsible for 90% of hepatitis deaths, and the remaining 10% are caused by other hepatitis viruses. The annual number of deaths from hepatitis C is declining, whereas the numbers of deaths from hepatitis B and D are increasing. Hepatitis B alone represents the seven highest cause of mortality worldwide. Spurred on by development of curative antivirals for hepatitis C and expanding access to hepatitis B virus (HBV) vaccination, the World Health Organization has committed to eliminating viral hepatitis as a public health threat by 2030. Like the majority of current antivirals, those available for HBV are virostatic. They are capable of suppressing viral replication but cannot eliminate the virus from infected patients. Therefore, treatment is lifelong. Long-term adherence to medication continues to represent a major challenge. Importantly, HBV often reactivates, leading to potential life-threatening events in immunosuppressed patients. Therapeutic options are limited for hepatitis D; however, promising new, effective antivirals are on the horizon. Recent advances have emerged in medicinal chemistry and drug delivery approaches to produce ultra-long-acting (XLA) antivirals. These can extend antiviral activity from months to 1 year or even longer. These new formulations can overcome the challenges of daily dosing and maximize drug exposure. The development of XLA antivirals targeting viral hepatitis may also facilitate cure strategies.
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Affiliation(s)
- Vicente Soriano
- UNIR Health Sciences School and Medical Centre, Madrid, Spain.
| | - Carmen Alvarez
- UNIR Health Sciences School and Medical Centre, Madrid, Spain
| | - Benson Edagwa
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Carmen de Mendoza
- Puerta de Hierro University Hospital and Research Foundation, Madrid, Spain
| | - Noemí Montoya
- UNIR Health Sciences School and Medical Centre, Madrid, Spain
| | - Ana Treviño
- UNIR Health Sciences School and Medical Centre, Madrid, Spain
| | - Howard Gendelman
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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24
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Lee AU, Lee C. Hepatitis D Review: Challenges for the Resource-Poor Setting. Viruses 2021; 13:v13101912. [PMID: 34696341 PMCID: PMC8538672 DOI: 10.3390/v13101912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/08/2021] [Accepted: 09/13/2021] [Indexed: 12/30/2022] Open
Abstract
Hepatitis D is the smallest virus known to infect humans, the most aggressive, causing the most severe disease. It is considered a satellite or defective virus requiring the hepatitis B surface antigen (HBsAg) for its replication with approximately 10–70 million persons infected. Elimination of hepatitis D is, therefore, closely tied to hepatitis B elimination. There is a paucity of quality data in many resource-poor areas. Despite its aggressive natural history, treatment options for hepatitis D to date have been limited and, in many places, inaccessible. For decades, Pegylated interferon alpha (Peg IFN α) offered limited response rates (20%) where available. Developments in understanding viral replication pathways has meant that, for the first time in over three decades, specific therapy has been licensed for use in Europe. Bulevirtide (Hepcludex®) is an entry inhibitor approved for use in patients with confirmed viraemia and compensated disease. It can be combined with Peg IFN α and/or nucleos(t)ide analogue for hepatitis B. Early reports suggest response rates of over 50% with good tolerability profile. Additional agents showing promise include the prenylation inhibitor lonafarnib, inhibitors of viral release (nucleic acid polymers) and better tolerated Peg IFN lambda (λ). These agents remain out of reach for most resource limited areas where access to new therapies are delayed by decades. strategies to facilitate access to care for the most vulnerable should be actively sought by all stakeholders.
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Affiliation(s)
- Alice U. Lee
- Concord Repatriation General Hospital, University of Sydney, Sydney, NSW 2139, Australia
- Hepatitis B Free, Sydney, NSW 2139, Australia
- Correspondence:
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Soriano V, Mendoza CD, Barreiro P, Treviño A, Corral O. Envisioning a hepatitis delta cure with new antivirals. Future Microbiol 2021; 16:927-930. [PMID: 34406066 DOI: 10.2217/fmb-2021-0177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
| | - Carmen de Mendoza
- Puerta de Hierro Research Institute & University Hospital, Majadahonda, Madrid, Spain
| | | | - Ana Treviño
- UNIR Health Sciences School & Medical Center, Madrid, Spain
| | - Octavio Corral
- UNIR Health Sciences School & Medical Center, Madrid, Spain
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26
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Gençdal G, Zeybel M, Yurdaydin C. Editorial: natural history of hepatitis delta virus-induced liver disease - less severe today but still needs attention. Aliment Pharmacol Ther 2021; 54:519-520. [PMID: 34331811 DOI: 10.1111/apt.16527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Genco Gençdal
- Department of Gastroenterology and Hepatology, Koç University Medical School, Istanbul, Turkey
| | - Müjdat Zeybel
- Department of Gastroenterology and Hepatology, Koç University Medical School, Istanbul, Turkey
| | - Cihan Yurdaydin
- Department of Gastroenterology and Hepatology, Koç University Medical School, Istanbul, Turkey
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