Main Topics

Chronic hepatitis Delta (CHD) affects approximately 10-20 million HBsAg carriers worldwide. HDV is a defective small RNA virus that requires HBsAg for its propagation. From the clinical point of view, if left untreated, the progression rate to cirrhosis and decompensation and HCC is 5-10 times greater that HBV monoinfection. Of note, there is uncertainty about diagnostic steps and optimal management algorithms for hepatitis Delta. For the last 30 years, antiviral treatment only relied on the off-label use of IFN or Peg-IFN alpha that is characterized by limited sustained response and an unfavorable tolerability and safety profile, but the treatment landscape is evolving rapidly. In 2020, Bulevirtide, the first in class entry inhibitor, has been approved for the treatment of CHD patients at the dose of 2 mg, s.c. Phase 2 studies have demonstrated its efficacy and safety but the phase III registration study is still ongoing. Real life data confirm the preliminary data of the clinical trials suggesting the possibility of a long-term suppressive therapy as monotherapy in some patients. Besides Bulevirtide, other clinical trials based on prenylation inhibitors, such as LNF + RTN, or peg-IFN lambda as monotherapy or combined with LNF+RTN are ongoing. In addition, several new therapeutics aimed to target HBsAg could be potentially very useful for HDV positive patients.
Forty-FIve years after the discovery of HDV by Mario Rizzetto, the Delta Cure 2022 meeting will shed new exciting lights on the management of this difficult-to-treat disease.