Treatment of chronic hepatitis delta with pegylated interferon-alpha2b.

BACKGROUND/AIMS: Chronic hepatitis D is difficult to treat. The present pilot study investigated the efficacy and tolerability of pegylated (PEG)-interferon (IFN)-alpha2b in chronic hepatitis D. PATIENTS AND METHODS: Twelve patients with chronic hepatitis D were prospectively treated with 1.5 microg/kg PEG-IFN-alpha2b for 48 weeks and followed for 24 weeks. Sustained response (SR) was defined as undetectable hepatitis delta virus (HDV) RNA by reverse transcriptase-polymerase chain reaction and normalization of alanine aminotransferase (ALT) at 6 months after treatment. Investigations included HDV RNA kinetics, determination of hepatitis B virus (HBV) and HDV genotypes and histological evaluation. RESULTS: An SR was achieved in two out of 12 of patients (17%). The negative predictive value of a less than 3 log HDV RNA decrease at month 6 was 100%. The positive predictive value of a more than 3 log HDV RNA decrease at month 6 was 67%. A marked ALT reduction at the end of treatment was observed in responders and nonresponders. Ishak histological score was comparable at baseline and significantly improved in responders compared with nonresponders at the end of follow-up (13.5 vs. 8.0; P<0.02). CONCLUSION: The present study indicates that PEG-IFN-alpha2b is a promising treatment option in chronic hepatitis D. Nonresponders could be identified by a less than 3 log decrease of HDV RNA at 6 months of treatment.

[Update hepatitis D]. / Update Hepatitis D.

The relevance of chronic hepatitis delta results from its high morbidity. Prevalence of hepatitis D decreases in classic endemic areas of the Mediterranean Basin, but increases in Eastern European countries. Hepatitis D is mainly a disease of immigrants in Germany. Hepatitis D virus (HDV) is an incomplete virus, which needs the hepatitis B surface protein (HBsAg) but not hepatitis B virus (HBV) replication for its propagation. In case of HBsAg detection a screening for HDV antibodies should be performed. Simultaneous HDV/HBV infection leading to spontaneous virus clearance in the majority of cases has to be differentiated from HDV superinfection with a high rate of chronification. Chronic hepatitis D is difficult to treat. Treatment regimens for hepatitis D are interferon-based so far. Pegylated interferons, a prolongation of treatment beyond 12 months, combination therapies with ribavirin and prenylation inhibitors are possibly new therapeutic options in chronic hepatitis C.