Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, United States.
World J Gastroenterol. 2019 Aug 28;25(32):4580-4597. doi: 10.3748/wjg.v25.i32.4580.
Chronic delta hepatitis is the most severe form of viral hepatitis affecting nearly 65 million people worldwide. Individuals with this devastating illness are at higher risk for developing cirrhosis and hepatocellular carcinoma. Delta virus is a defective RNA virus that requires hepatitis B surface antigen for propagation in humans. Infection can occur in the form of a co-infection with hepatitis B, which can be self-limiting, superinfection in a patient with established hepatitis B infection, which often leads to chronicity in majority of cases. Current noninvasive tools to assess for advanced liver disease have limited utility in delta hepatitis. Guidelines recommend treatment with pegylated interferon, but this is limited to patients with compensated disease and is efficacious in about 30% of those treated. Due to limited treatment options, novel agents are being investigated and include entry, assembly and export inhibitors of viral particles in addition to stimulators of the host immune response. Future clinical trials should take into consideration the interaction of hepatitis B and hepatitis D as suppression of one virus can lead to the activation of the other. Also, surrogate markers of treatment efficacy have been proposed.
慢性 delta 肝炎是影响全球近 6500 万人的最严重形式的病毒性肝炎。患有这种毁灭性疾病的人患肝硬化和肝细胞癌的风险更高。Delta 病毒是一种缺陷型 RNA 病毒，在人类中需要乙型肝炎表面抗原才能繁殖。感染可以以与乙型肝炎的合并感染形式发生，这种感染可能是自限性的，也可以在已感染乙型肝炎的患者中发生超感染，这种情况在大多数情况下往往会导致慢性化。目前用于评估晚期肝病的非侵入性工具的实用性有限。指南建议使用聚乙二醇干扰素治疗，但这仅限于代偿性疾病患者，并且在接受治疗的患者中约有 30%有效。由于治疗选择有限，正在研究新型药物，包括病毒颗粒的进入、组装和出口抑制剂以及宿主免疫反应的刺激剂。未来的临床试验应考虑乙型肝炎和 delta 肝炎的相互作用，因为一种病毒的抑制可能会导致另一种病毒的激活。此外，还提出了治疗效果的替代标志物。
