Published online Aug 28, 2019. doi: 10.3748/wjg.v25.i32.4580
Peer-review started: May 21, 2019
First decision: June 9, 2019
Revised: July 3, 2019
Accepted: July 19, 2019
Article in press: July 19, 2019
Published online: August 28, 2019
Processing time: 99 Days and 16.8 Hours
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, vs 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.
Core tip: Delta hepatitis is a progressive disease affecting millions worldwide. Current treatment options have limited efficacy. This review focuses on the history of interferon therapy, novel therapies that have been developed and future treatment options for a possible functional cure.