Because of this unique method of replication,
HDV has obtained its own genus (Deltavirus). Five percent of all Ibrutinib order HBV-positive patients are expected to be HDV-positive, although we should keep in mind that there are significant regional differences in prevalence. Chronic delta hepatitis can cause the most severe form of viral hepatitis known to date,2 and a standard therapy regimen has not been established yet. Two paths of infection and two subsequent courses of disease are possible: a coinfection with hepatitis B (with a high risk of fulminant hepatitis and a 95% chance of the clearance of both viruses) and a superinfection with preexisting hepatitis B (with the possibility of fulminant hepatitis and/or severe chronic disease). Patients with chronic hepatitis B who acquire an HDV superinfection have a high risk of developing liver cirrhosis.3, 4 For Hep-Net International Delta Hepatitis Intervention Trial I (HIDIT-I), Wedemeyer et al.5 recruited 90 patients with chronic hepatitis B and D coinfections from multiple centers in Germany, Greece, and Turkey and compared three different Nutlin-3a therapy regimens: pegylated interferon alfa-2a
(PEG-IFNα2a) and a placebo (n = 29), PEG-IFNα2a and adefovir (ADV; n = 32), and ADV alone (n = 30) for 48 weeks. Eighty patients completed the study (89%), and follow-up was performed for another 24 weeks. Among others, the primary and secondary endpoints were the normalization of alanine aminotransferase levels, the clearance of HDV RNA, and a significant decline in HBsAg levels. Wedemeyer et al.5 found that 48 weeks of therapy with PEG-IFNα2a, alone or in combination
with ADV, significantly reduced HDV RNA levels, with 28% of the patients clearing the virus within 24 weeks of the end of therapy. Treatment with ADV alone had no significant effect on HDV clearance after 24 weeks, although the suppression of HBV DNA under therapy was best MCE公司 in the ADV group. These results are consistent with earlier studies evaluating PEG-IFN as an effective therapeutic agent.6, 7 HDV has (at least) eight different genotypes. These eight different clades have specific distributions in different regions of the world.8 In all patients of this study, genotype 1 was detected. Genotype 1 is characteristic for Caucasian patients from Europe and can cause severe chronic disease. Different pathological effects dependent on the different genotypes have been discussed in the past (see Fig. 1 for further details). Because the clinical course of the disease can differ with the genotype,9 we do not know whether positive data on the effects of PEG-IFNα2a treatment can be assigned to the other genotypes.