Abstract
Hepatitis delta is the most severe of all chronic viral infections of the liver. Its
agent, the hepatitis delta virus (HDV), is unique in many aspects. Because of similar
transmission pathways, triple infection with human immunodeficiency virus (HIV), hepatitis
B virus (HBV), and HDV occurs frequently in intravenous drug users. The addition of
HDV to an HIV/HBV coinfection is associated with a particularly aggressive course
of liver disease, frequently leading to cirrhosis, decompensation, and death. Thus,
screening for antibodies against HDV should be mandatory in all HBsAg-positive/HIV-positive
patients. There is no specific treatment for HDV. The only therapeutic options currently
available are long-duration interferon regimens, which are effective in <30% of the
patients. Additionally, long-term treatment with HBV polymerase inhibitors as part
of antiretroviral treatment may lower HBsAg- and HDV-ribonucleic acid levels in some
patients. Early initiation of anti-HIV therapy seems to be reasonable in patients
with hepatitis delta – even though controlled studies are not available.
Keywords
hepatitis delta virus - HDV - HIV - hepatitis B virus - HBV - coinfection - multiple
hepatitis infections
