CLINICAL AND MOLECULAR BASIS OF HEPATITIS D THERAPY (literature review)
Keywords:
HDV, HBV, TCP receptor, vaccination, pegylated interferon, bulevirtide, lonafarnib, nucleic acid polymers, virological response, HDV replication, HDV therapy.Abstract
Introduction. Hepatitis D (HDV) is a satellite virus completely dependent on HBV, characterized by high pathogenicity and rapid progression of cirrhosis. Diagnostics is based on the detection of anti-HDV and HDV RNA. The effectiveness of therapy is limited, new targeted drugs are being developed, and vaccination against HBV remains a key method for preventing HDV infection.
The aim of the study was to analyze modern clinical and molecular aspects of HDV therapy.
Material and methods. The study included an analysis of 29 articles from Web of Science and PubMed (1980-2024) on HDV therapy. Key terms: HDV, HBV, vaccination, pegylated interferon, bulevirtide. Included meta-analyses, original, and cohort studies. Works without access to the text or irrelevant to these criteria are excluded.
Results and discussion. Current treatment options for chronic hepatitis D include three approaches: entry inhibitors (bulevirtide), virion assembly blockers (lonafarnib), and suppression of viral release (nucleic acid polymers). Bulevirtide, which blocks the NTCP receptor, in combination with pegylated interferon, demonstrates a sustained virological response in 85% of patients, but requires long-term therapy due to the risk of relapse. Lonafarnib in combination with ritonavir and interferon-λ provides HDV RNA clearance in 42% of patients with an improved safety profile. The REP 2139-Ca polymer demonstrated HBsAg elimination in 33% of patients, which persisted for 3.5 years. Despite the progress, randomized trials are needed to confirm long-term efficacy and optimize treatment regimens.
Conclusion. HDV therapy is complicated by high infectivity and persistence of the virus in the liver, which makes it difficult to achieve sustained remission. Optimal treatment endpoints and long-term outcomes of new drugs require further study. Combination regimens remain the most promising, and HDV prophylaxis is provided by HBV vaccination.
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