Journal of the Formosan Medical Association
Volume 105, Issue 11 , Pages 869-881, 2006

Natural Course and Treatment of Hepatitis D Virus Infection

  • Ting-Hui Hsieh

      Affiliations

    • Department of Medicine, Maimonides Medical Center, New York, USA
    • Division of Gastroenterology, Department of Internal Medicine, Taipei, Taiwan
  • ,
  • Chun-Jen Liu

      Affiliations

    • Division of Gastroenterology, Department of Internal Medicine, Taipei, Taiwan
  • ,
  • Ding-Shinn Chen

      Affiliations

    • Division of Gastroenterology, Department of Internal Medicine, Taipei, Taiwan
    • Graduate Institute of Clinical Medicine, Taipei, Taiwan
    • Hepatitis Research Center, Taipei, Taiwan
  • ,
  • Pei-Jer Chen

      Affiliations

    • Division of Gastroenterology, Department of Internal Medicine, Taipei, Taiwan
    • Graduate Institute of Clinical Medicine, Taipei, Taiwan
    • Hepatitis Research Center, Taipei, Taiwan
    • Department of Medical Research, National Taiwan University College of Medicine, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Professor Pei-Jer Chen, Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei 100, Taiwan

Received 30 December 2005; received in revised form 15 March 2006; accepted 30 June 2006.

Article Outline

Hepatitis D virus (HDV) is a subviral satellite with hepatitis B virus (HBV) as its natural helper virus. After entry into hepatocytes, it utilizes host cellular enzymes to replicate by a double-rolling-circle mechanism. HDV is most often transmitted by contact with contaminated blood and body fluid, similar to HBV infection. Approximately 5% of the global HBV carriers are coinfected with HDV, leading to a total of 10-15 million HDV carriers worldwide. HDV infection can occur concurrently with HBV infection (coinfection) or in a patient with established HBV infection (superinfection). The pathogenesis of HDV remains controversial. A decline in the prevalence of both acute and chronic hepatitis D (CHD) has been observed worldwide. At present, therapy for chronic HDV infection is by the use of interferon-a. Compared to chronic hepatitis B or C, CHD treatment requires a higher dosage and a longer duration of treatment, and post-treatment relapses are common. In order to prevent the progression of CHD and its related morbidity and mortality, more effective treatments are needed.

Key Words:  genotype , hepatitis B virus , hepatitis D virus , seroepidemiology , treatment

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Rizzetto M , Canese MG , Arico S , et al.   Immunofluores-cence detection of new antigen-antibody system (delta/ anti-delta) associated to hepatitis B virus in liver and in serum of HBsAg carriers . Gut . 1977;18:997–1003
  2. Rizzetto M , Hoyer B , Canese MG , et al.   delta Agent: association of delta antigen with hepatitis B surface antigen and RNA in serum of delta-infected chimpanzees . Proc Natl Acad Sci USA . 1980;77:6124–6128
  3. Lai MM . The molecular biology of hepatitis delta virus . Annu Rev Biochem . 1995;64:259–286
  4. Kos A , Dijkema R , Arnberg AC , et al.   The hepatitis delta (delta) virus possesses a circular RNA . Nature . 1986;323:558–560
  5. Wang KS , Choo QL , Weiner AJ , et al.   Structure, sequence and expression of the hepatitis delta (delta) viral genome . Nature . 1986;323:508–514
  6. Chen PJ , Kalpana G , Goldberg J , et al.   Structure and replication of the genome of the hepatitis delta virus . Proc Natl Acad Sci USA . 1986;83:8774–8778
  7. Weiner AJ , Choo QL , Wang KS , et al.   A single antigenomic open reading frame of the hepatitis delta virus encodes the epitope(s) of both hepatitis delta antigen polypeptides p24 delta and p27 delta . J Virol . 1988;62:594–599
  8. Sureau C , Moriarty AM , Thornton GB , et al.   Production of infectious hepatitis delta virus in vitro and neutralization with antibodies directed against hepatitis B virus pre-S antigens . J Virol . 1992;66:1241–1245
  9. Taylor JM . The structure and replication of hepatitis delta virus . Annu Rev Microbiol . 1992;46:253–276
  10. Sharmeen L , Kuo MY , Dinter-Gottlieb G , et al.   Anti-genomic RNA of human hepatitis delta virus can undergo self-cleavage . J Virol . 1988;62:2674–2679
  11. Branch AD , Robertson HD . A replication cycle for viroids and other small infectious RNAs . Science . 1984;223:450–455
  12. Fu TB , Taylor J . The RNAs of hepatitis delta virus are copied by RNA polymerase II in nuclear homogenates . J Virol . 1993;67:6965–6972
  13. Shih IH , Been MD . Catalytic strategies of the hepatitis delta virus ribozymes . Annu Rev Biochem . 2002;71:887–917
  14. Polson AG , Bass BL , Casey JL . RNA editing of hepatitis delta virus antigenome by dsRNA-adenosine deaminase . Nature . 1996;380:454–456
  15. Bass BL . RNA editing by adenosine deaminases that act on RNA . Annu Rev Biochem . 2002;71:817–846
  16. O'Malley B , Lazinski DW . Roles of carboxyl-terminal and farnesylated residues in the functions of the large hepatitis delta antigen . J Virol . 2005;79:1142–1153
  17. Lee CZ , Chen PJ , Lai MM , et al.   Isoprenylation of large hepatitis delta antigen is necessary but not sufficient for hepatitis delta virus assembly . Virology . 1994;199:169–175
  18. Mu JJ , Chen DS , Chen PJ . The conserved serine 177 in the delta antigen of hepatitis delta virus is one putative phosphorylation site and is required for efficient viral RNA replication . J Virol . 2001;75:9087–9095
  19. Mu JJ , Wu HL , Chiang BL , et al.   Characterization of the phosphorylated forms and the phosphorylated residues of hepatitis delta virus delta antigens . J Virol . 1999;73:10540–10545
  20. Mu JJ , Tsay YG , Juan LJ , et al.   The small delta antigen of hepatitis delta virus is an acetylated protein and acetyla-tion of lysine 72 may influence its cellular localization and viral RNA synthesis . Virology . 2004;319:60–70
  21. Li YJ , Stallcup MR , Lai MM . Hepatitis delta virus antigen is methylated at arginine residues, and methylation regulates subcellular localization and RNA replication . J Virol . 2004;78:13325–13334
  22. Bordier BB , Ohkanda J , Liu P , et al.   In vivo antiviral efficacy of prenylation inhibitors against hepatitis delta virus . J Clin Invest . 2003;112:407–414
  23. Hadziyannis SJ . Decreasing prevalence of hepatitis D virus infection . J Gastroenterol Hepatol . 1997;12:745–746
  24. Farci P . Delta hepatitis: an update . J Hepatol . 2003;39(Suppl 1):S212–S219
  25. Huo TI , Wu JC , Wu SI , et al.   Changing seroepidemiology of hepatitis B, C, and D virus infections in high-risk populations . J Med Virol . 2004;72:41–45
  26. Gaeta GB , Stroffolini T , Chiaramonte M , et al.   Chronic hepatitis D: a vanishing disease? An Italian multicenter study . Hepatology . 2000;32(4 Pt 1):824–827
  27. di Bisceglie AM . Interferon therapy for chronic viral hepatitis . N Engl J Med. . 1994;330:137–138
  28. Chen DS . Viral hepatitis: from A to E, and beyond? . J Formos Med Assoc . 2003;102:671–679
  29. Rizzetto M , Hadziyannis S , Hansson BG , et al.   Hepatitis delta virus infection in the world: epidemiological patterns and clinical expression . Gastroenterol Int . 1992;5:18–32
  30. Toukan AU , al-Kandari S . The role of hepatitis D virus in liver disease in the Middle East . Prog Clin Biol Res. . 1991;364:63–68
  31. Casey JL , Brown TL , Colan EJ , et al.   A genotype of hepatitis D virus that occurs in northern South America . Proc Natl Acad Sci USA . 1993;90:9016–9020
  32. Anonymous  . Centers for Disease Control. Hepatitis Surveillance Report . MMWR . 1990;53:23
  33. Rizzetto M , Ponzetto A , Forzani I . Epidemiology of hepatitis delta virus: overview . Prog Clin Biol Res. . 1991;364:1–20
  34. Mumtaz K , Hamid SS , Adil S , et al.   Epidemiology and clinical pattern of hepatitis delta virus infection in Pakistan . J Gastroenterol Hepatol . 2005;20:1503–1507
  35. Sakugawa H , Nakasone H , Shokita H , et al.   Seroepi-demiological study of hepatitis delta virus infection in Okinawa, Japan . J Med Virol . 1995;45:312–315
  36. Singh V , Goenka MK , Bhasin DK , et al.   A study of hepatitis delta virus infection in patients with acute and chronic liver disease from northern India . J Viral Hepat . 1995;2:151–154
  37. Dalekos GN , Zervou E , Karabini F , et al.   Prevalence of viral markers among refugees from southern Albania: increased incidence of infection with hepatitis A, B and D viruses . Eur J Gastroenterol Hepatol . 1995;7:553–558
  38. Manock SR , Kelley PM , Hyams KC , et al.   An outbreak of fulminant hepatitis delta in the Waorani, an indigenous people of the Amazon basin of Ecuador . Am J Trop Med Hyg . 2000;63:209–213
  39. Lee CM , Bih FY , Chao YC , et al.   Evolution of hepatitis delta virus RNA during chronic infection . Virology . 1992;188:265–273
  40. Chao YC , Chang MF , Gust I , et al.   Sequence conservation and divergence of hepatitis delta virus RNA . Virology . 1990;178:384–392
  41. Wu JC , Chen CM , Sheen IJ , et al.   Evidence of transmission of hepatitis D virus to spouses from sequence analysis of the viral genome . Hepatology . 1995;22:1656–1660
  42. Negro F , Rizzetto M . Diagnosis of hepatitis delta virus infection . J Hepatol . 1995;22:136–139
  43. Hsu SC , Syu WJ , Ting LT , et al.   Immunohistochemical differentiation of hepatitis D virus genotypes . Hepatology . 2000;32:1111–1116
  44. Shakil AO , Hadziyannis S , Hoofnagle JH , et al.   Geographic distribution and genetic variability of hepatitis delta virus genotype I . Virology . 1997;234:160–167
  45. Su CW , Huang YH , Huo TI , et al.   Genotypes and viremia of hepatitis B and D viruses are associated with outcomes of chronic hepatitis D patients . Gastroenterology . 2006;130:1625–1635
  46. Wu JC , Choo KB , Chen CM , et al.   Genotyping of hepatitis D virus by restriction-fragment length polymorphism and relation to outcome of hepatitis D . Lancet . 1995;346:939–941
  47. Hsu SC , Syu WJ , Sheen IJ , et al.   Varied assembly and RNA editing efficiencies between genotypes I and II hepatitis D virus and their implications . Hepatology . 2002;35:665–672
  48. Casey JL , Niro GA , Engle RE , et al.   Hepatitis B virus (HBV)/hepatitis D virus (HDV) coinfection in outbreaks of acute hepatitis in the Peruvian Amazon basin: the roles of HDV genotype III and HBV genotype F . J Infect Dis . 1996;174:920–926
  49. Nakano T , Shapiro CN , Hadler SC , et al.   Characterization of hepatitis D virus genotype III among Yucpa Indians in Venezuela . J Gen Virol . 2001;82:2183–2189
  50. Kao JH , Chen PJ , Lai MY , et al.   Hepatitis D virus genotypes in intravenous drug users in Taiwan: decreasing prevalence and lack of correlation with hepatitis B virus genotypes . J Clin Microbiol . 2002;40:3047–3049
  51. Radjef N , Gordien E , Ivaniushina V , et al.   Molecular phylo-genetic analyses indicate a wide and ancient radiation of African hepatitis delta virus, suggesting a deltavirus genus of at least seven major clades . J Virol . 2004;78:2537–2544
  52. Rosina F , Saracco G , Rizzetto M . Risk of post-transfusion infection with the hepatitis delta virus. A multicenter study . N Engl J Med. . 1985;312:1488–1491
  53. Wu JC , Lee SD , Govindarajan S , et al.   Sexual transmission of hepatitis D virus infection in Taiwan . Hepatology . 1990;11:1057–1061
  54. Bonino F , Caporaso N , Dentico P , et al.   Familiar clustering and spreading of hepatitis delta virus infection . J Hepatol . 1985;1:221–226
  55. Niro GA , Casey JL , Gravinese E , et al.   Intrafamilial transmission of hepatitis delta virus: molecular evidence . J Hepatol . 1999;30:564–569
  56. Rosina F , Conoscitore P , Cuppone R , et al.   Changing pattern of chronic hepatitis D in Southern Europe . Gastroenterology . 1999;117:161–166
  57. Huo TI , Wu JC , Lin RY , et al.   Decreasing hepatitis D virus infection in Taiwan: an analysis of contributory factors . J Gastroenterol Hepatol . 1997;12:747–751
  58. Ni YH , Chang MH , Huang LM , et al.   Hepatitis B virus infection in children and adolescents in a hyperendemic area: 15 years after mass hepatitis B vaccination . Ann Intern Med. . 2001;135:796–800
  59. Caredda F , d'Arminio Monforte A , Rossi E , et al.   Prospective study of epidemic delta infection in drug addicts . Prog Clin Biol Res. . 1983;143:245–250
  60. Wu JC , Chen TZ , Huang YS , et al.   Natural history of hepatitis D viral superinfection: significance of viremia detected by polymerase chain reaction . Gastroenterology . 1995;108:796–802
  61. Liaw YF , Chen YC , Sheen IS , et al.   Impact of acute hepatitis C virus superinfection in patients with chronic hepatitis B virus infection . Gastroenterology . 2004;126:1024–1029
  62. Wu JC , Lee SD , Govindarajan S , et al.   Correlation of serum delta RNA with clinical course of acute hepatitis delta virus superinfection in Taiwan: a longitudinal study . J Infect Dis . 1990;161:1116–1120
  63. Saracco G , Rosina F , Brunetto MR , et al.   Rapidly progressive HBsAg-positive hepatitis in Italy. The role of hepatitis delta virus infection . J Hepatol . 1987;5:274–281
  64. Chen PJ , Chen DS , Chen CR , et al.   Delta infection in asymptomatic carriers of hepatitis B surface antigen: low prevalence of delta activity and effective suppression of hepatitis B virus replication . Hepatology . 1988;8:1121–1124
  65. Wu JC , Chen CM , Chen TZ , et al.   Prevalence and type of precore hepatitis B virus mutants in hepatitis D virus su-perinfection and its clinical implications . J Infect Dis . 1996;173:457–459
  66. Huo TI , Wu JC , Lai CR , et al.   Comparison of clinico-pathological features in hepatitis B virus-associated hepa-tocellular carcinoma with or without hepatitis D virus superinfection . J Hepatol . 1996;25:439–444
  67. Smedile A , Rosina F , Saracco G , et al.   Hepatitis B virus replication modulates pathogenesis of hepatitis D virus in chronic hepatitis D . Hepatology . 1991;13:413–416
  68. Liaw YF , Dong JT , Chiu KW , et al.   Why most patients with hepatitis delta virus infection are seronegative for hepatitis B e antigen. A prospective controlled study . J Hepatol . 1991;12:106–109
  69. Macagno S , Smedile A , Caredda F , et al.   Monomeric (7S) immunoglobulin M antibodies to hepatitis delta virus in hepatitis type D . Gastroenterology . 1990;98:1582–1586
  70. Borghesio E , Rosina F , Smedile A , et al.   Serum immuno-globulin M antibody to hepatitis D as a surrogate marker of hepatitis D in interferon-treated patients and in patients who underwent liver transplantation . Hepatology . 1998;27:873–876
  71. Sakugawa H , Nakasone H , Nakayoshi T , et al.   Hepatitis B virus concentrations in serum determined by sensitive quantitative assays in patients with established chronic hepatitis delta virus infection . J Med Virol . 2001;65:478–484
  72. Hadziyannis SJ , Sherman M , Lieberman HM , et al.   Liver disease activity and hepatitis B virus replication in chronic delta antigen-positive hepatitis B virus carriers . Hepatology . 1985;5:544–547
  73. Wu JC , Li CS , Chen CL , et al.   Factors associated with viremia and elevated transaminase levels in asymptomatic hepatitis D virus-infected risk groups . J Med Virol . 1994;42:86–90
  74. Bichko V , Netter HJ , Wu TT , et al.   Pathogenesis associated with replication of hepatitis delta virus . Infect Agents Dis . 1994;3:94–97
  75. Gowans EJ , Bonino F . Hepatitis delta virus pathogenicity . Prog Clin Biol Res. . 1993;382:125–130
  76. MacNaughton TB , Gowans EJ , Jilbert AR , et al.   Hepatitis delta virus RNA, protein synthesis and associated cytotox-icity in a stably transfected cell line . Virology . 1990;177:692–698
  77. MacNaughton TB , Gowans EJ , Reinboth B , et al.   Stable expression of hepatitis delta virus antigen in a eukaryotic cell line . J Gen Virol . 1990;71:1339–1345
  78. Cole SM , Gowans EJ , MacNaughton TB , et al.   Direct evidence for cytotoxicity associated with expression of hepatitis delta virus antigen . Hepatology . 1991;13:845–851
  79. Negro F , Baldi M , Bonino F , et al.   Chronic HDV (hepatitis delta virus) hepatitis. Intrahepatic expression of delta antigen, histologic activity and outcome of liver disease . J Hepatol . 1988;6:8–14
  80. Philipp T , Durazzo M , Trautwein C , et al.   Recognition of uridine diphosphate glucuronosyl transferases by LKM-3 antibodies in chronic hepatitis D . Lancet . 1994;344:578–581
  81. Farci P , Mandas A , Coiana A , et al.   Treatment of chronic hepatitis D with interferon alfa-2a . N Engl J Med. . 1994;330:88–94
  82. Gaudin JL , Faure P , Godinot H , et al.   The French experience of treatment of chronic type D hepatitis with a 12-month course of interferon alpha-2B. Results of a randomized controlled trial . Liver . 1995;15:45–52
  83. Lau DT , Doo E , Park Y , et al.   Lamivudine for chronic delta hepatitis . Hepatology . 1999;30:546–549
  84. Wolters LM , van Nunen AB , Honkoop P , et al.   Lamivudine-high dose interferon combination therapy for chronic hepatitis B patients co-infected with the hepatitis D virus . J Viral Hepat . 2000;7:428–434
  85. Yurdaydin C , Bozkaya H , Gurel S , et al.   Famciclovir treatment of chronic delta hepatitis . J Hepatol . 2002;37:266–271
  86. Rosina F , Conoscitore P , Smedile A , et al.   Treatment of chronic hepatitis D with thymus-derived polypeptide thymic humoral factor-gamma 2: a pilot study . Dig Liver Dis . 2002;34:285–289
  87. Niro GA , Ciancio A , Tillman HL , et al.   Lamivudine therapy in chronic delta hepatitis: a multicentre randomized-controlled pilot study . Aliment Pharmacol Ther . 2005;22:227–232
  88. Kaymakoglu S , Karaca C , Demir K , et al.   Alpha interferon and ribavirin combination therapy of chronic hepatitis D . Antimicrob Agents Chemother . 2005;49:1135–1138
  89. Gunsar F , Akarca US , Ersoz G , et al.   Two-year interferon therapy with or without ribavirin in chronic delta hepatitis . Antivir Ther . 2005;10:721–726
  90. Castelnau C , Gal FL , Ripault M , et al.   Efficacy of peg-interferon alpha-2b in chronic hepatitis delta: relevance of quantitative RT-PCR for follow-up . Hepatology . 2006;44:728–735
  91. Niro GA , Ciancio A , Gaeta GB , et al.   Pegylated interferon alpha-2b as monotherapy or in combination with ribavirin in chronic hepatitis delta . Hepatology . 2006;44:713–720
  92. Farci P , Roskams T , Chessa L , et al.   Long-term benefit of interferon alpha therapy of chronic hepatitis D: regression of advanced hepatic fibrosis . Gastroenterology . 2004;126:1740–1749
  93. Lau DT , Kleiner DE , Park Y , et al.   Resolution of chronic delta hepatitis after 12 years of interferon alfa therapy . Gastroenterology . 1999;117:1229–1233
  94. Kleiner D , Di Bisceglie AM , Axiotis CA , et al.   Prolonged alpha interferon therapy for chronic delta hepatitis: effect on liver histopathology . Prog Clin Biol Res. . 1993;382:365–371
  95. Marzano A , Ottobrelli A , Spezia C , et al.   Treatment of early chronic delta hepatitis with lymphoblastoid alpha interferon: a pilot study . Ital J Gastroenterol . 1992;24:119–121
  96. Heathcote EJ , Shiffman ML , Cooksley WG , et al.   Peginter-feron alfa-2a in patients with chronic hepatitis C and cirrhosis . N Engl J Med. . 2000;343:1673–1680
  97. Zeuzem S , Feinman SV , Rasenack J , et al.   Peginterferon alfa-2a in patients with chronic hepatitis C . N Engl J Med. . 2000;343:1666–1672
  98. Fried MW , Shiffman ML , Reddy KR , et al.   Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection . N Engl J Med. . 2002;347:975–982
  99. Ferenci P , Formann E , Romeo R . Successful treatment of chronic hepatitis D with a short course of peginter-feron alfa-2a . Am J Gastroenterol . 2005;100:1626–1627
  100. Zavaglia C , Bottelli R , Smedile A , et al.   A pilot study of thymosin-alpha 1 therapy for chronic hepatitis D . J Clin Gastroenterol . 1996;23:162–163
  101. Rasshofer R , Choi SS , Wolfl P , et al.   Interference of antiviral substances with replication of hepatitis delta virus RNA in primary woodchuck hepatocytes . Prog Clin Biol Res. . 1991;364:223–234
  102. Buti M , Esteban R , Jardi R , et al.   Ribavirin therapy in chronic delta hepatitis . J Hepatol . 1993;19:318
  103. Andreone P , Spertini F , Negro F . Lamivudine-associated remission of chronic hepatitis delta . Ann Intern Med. . 2000;132:598
  104. Vietheer PT , Netter HJ , Sozzi T , et al.   Failure of the lamivudine-resistant rtM204I hepatitis B virus mutants to efficiently support hepatitis delta virus secretion . J Virol . 2005;79:6570–6573
  105. Lai MY , Kao JH , Yang PM , et al.   Long-term efficacy of ribavirin plus interferon alfa in the treatment of chronic hepatitis C . Gastroenterology . 1996;111:1307–1312
  106. Poynard T , Marcellin P , Lee SS , et al.   Randomised trial of interferon alpha2b plus ribavirin for 48 weeks or for 24 weeks versus interferon alpha2b plus placebo for 48 weeks for treatment of chronic infection with hepatitis C virus. International Hepatitis Interventional Therapy Group (IHIT) . Lancet . 1998;352:1426–1432
  107. Berk L , de Man RA , Housset C , et al.   Alpha lymphoblas-toid interferon and acyclovir for chronic hepatitis delta . Prog Clin Biol Res. . 1991;364:411–420
  108. Chang J , Taylor JM . Susceptibility of human hepatitis delta virus RNAs to small interfering RNA action . J Virol . 2003;77:9728–9731
  109. Chang J , Provost P , Taylor JM . Resistance of human hepatitis delta virus RNAs to dicer activity . J Virol . 2003;77:11910–11917
  110. Einav S , Glenn JS . Prenylation inhibitors: a novel class of antiviral agents . J Antimicrob Chemother . 2003;52:883–886
  111. Huang YH , Wu JC , Tao MH , et al.   DNA-Based immunization produces Th1 immune responses to hepatitis delta virus in a mouse model . Hepatology . 2000;32:104–110
  112. Kao JH , Chen DS . Recent updates in hepatitis vaccination and the prevention of hepatocellular carcinoma . Int J Cancer . 2002;97:269–271

PII: S0929-6646(09)60172-8

doi:10.1016/S0929-6646(09)60172-8

Journal of the Formosan Medical Association
Volume 105, Issue 11 , Pages 869-881, 2006