Management of autoimmune hepatitis induced by hepatitis delta virus

Figure 1 Management of autoimmune hepatitis induced by hepatitis delta virus. Assess all hepatitis B surface antigen (+) patients for anti-hepatitis delta virus (HDV). For anti-HDV positive patients evaluate HDV-RNA status and autoimmune hepatitis (AIH). Consider liver biopsy for patients with serologic evidence of AIH: (1) Initiate BLV for HDV-RNA (+) and AIH (+). If there is biochemical response continue bulevirtide (BLV); If there is partial or no biochemical response use AIH targeted therapies; and (2) If HDV-RNA (-) and AIH (+) initiate treatment for AIH. If there is biochemical response continue AIH treatment; if there is partial or no biochemical response check HDV-RNA and if positive add BLV, otherwise proceed to 2^nd line treatment for AIH. HDV: Hepatitis delta virus; HBV: Hepatitis B virus; AIH: Autoimmune hepatitis; ANA: Antinuclear antibodies; SMA: Smooth muscle autoantibodies; BLV: Bulevirtide; ANCA: Anti-neutrophil cytoplasmic antibodies; IgG: Immunoglobulin G; HBsAG: Hepatitis B surface antigen.