Hepatitis D virus infection: Pathophysiology, epidemiology and treatment. Report from the first international delta cure meeting 2022
Pietro Lampertico, Elisabetta Degasperi, Lisa Sandmann, Heiner Wedemeyer, Cihan Yurdaydın, Dominique Roulot, Fabien Zoulim, Florin Alexandru Căruntu, Heiner Wedemeyer, Helenie Kefalakes, Julie Lucifora, Kosh Agarwal, Laurent Castéra, Marı́a Buti, Mario Rizzetto, Markus Cornberg, Maura Dandri, Maurizia Rossana Brunetto, Nancy Reau, Robert G. Gish, Saeed Hamid, Soo Aleman, Stephan Urban, Tarik Asselah, Thomas Berg, Victor de Lédinghen
Abstract
Chronic infection with hepatitis Delta virus (HDV) affects between 12-20 million people worldwide and represents the most severe form of viral hepatitis, leading to accelerated liver disease progression, cirrhosis and its complications, such as end-stage-liver disease and hepatocellular carcinoma. From HDV discovery in 1977 by Prof. Mario Rizzetto, knowledge has expanded about HDV life cycle and mechanisms of viral spreading. However, little is still known about natural history of the disease, host-viral interactions, and role of immune system in HDV persistence. Diagnosis of HDV is still challenging due to lack of standardized assays, while accurate viral load quantification is needed to assess response and endpoints of antiviral treatment. Until recently, Interferon (IFN) has represented the only treatment option in patients with chronic hepatitis Delta, however it resulted in low efficacy and high burden of side effects. The discovery of the entry inhibitor Bulevirtide has represented a breakthrough in HDV treatment, by providing high rates of viral suppression, results of Phase II and III trials being confirmed also in real-life settings and in compensated advanced liver disease patients. In the meantime, other compounds (i.e. Lonafarnib, new anti-HBV drugs) are under development to provide alternative or combined strategies for HDV cure. To share and disseminate most recent data, the first international Delta Cure Meeting was organized in Milan in October 2022; this review summarizes key takeaway messages from state-of-the-art lectures as well as research data concerning HDV field.