Bulevirtide Monotherapy or in Combination for Chronic Hepatitis Delta: 2025 Update

作者：Pietro Lampertico, Maria Paola Anolli, Katja Steppich, Heiner H. Wedemeyer · 发表于：Journal of Viral Hepatitis · 年份：2025 · DOI：10.1111/jvh.70056 · 被引用次数：11 · 研究领域：Hepatitis B Virus Studies、Hepatitis C virus research、Hepatitis Viruses Studies and Epidemiology

Chronic hepatitis Delta (CHD) represents the most aggressive form of viral hepatitis. In the latest estimates, published in 2024 by the Polaris Observatory, the overall prevalence of the hepatitis Delta virus (HDV) in Hepatitis B surface antigen (HBsAg) + patients was estimated to be 2% worldwide, a lower figure than what was previously estimated to be around 6%-11%. Prevalence figures vary greatly across the globe, with the highest anti-HDV+ prevalence in Mongolia, where it reaches 60% of HBsAg+ individuals. Its clinical manifestations include accelerated progression to cirrhosis, increased risk of hepatic decompensation and heightened incidence of hepatocellular carcinoma (HCC). Notwithstanding the close dependency of HDV on the Hepatitis B virus (HBV), requiring HBsAg for cellular entry and propagation, nucleos(t)ide analogue (NA) therapies do not affect CHD. Ideally, a therapy capable of achieving HBsAg loss would also translate into CHD cure. Monitoring viremia is pivotal in estimating the effectiveness of HDV treatments. Consequently, a "virological response" is defined as a reduction of at least 2 logs in HDV RNA or achieving HDV RNA negativity, compared to baseline. Despite the crucial role of HDV RNA monitoring in managing patients with CHD, significant variability still exists in nucleic acid quantification techniques for HDV RNA. Quantification assays differ in their sensitivity. As previously mentioned, antiviral therapy for CHD had been challenging for decades. U...