New therapy for hepatitis D

Researchers discovered efficient hepatitis D therapy

28/01/2011

Scientists have discovered an effective therapy for hepatitis D, which can be used for virological healing in a quarter of cases of hepatitis D infection.

The treatment with peginterferon alfa-2a already used for the treatment of hepatitis B and C also shows its effect on hepatitis D, the researchers said „Hep-Net International Delta Hepatitis Interventional Trial” (HIDIT) study group around Michael Manns and Heiner Wedemeyer of the Hannover Medical School (MHH) in the latest issue of the New England Journal of Medicine. In principle, the treatment with peginterferon alfa-2a in hepatitis is an effective therapy, Wedemeyer and Manns emphasized.

Hepatitis D virus uses the envelope of hepatitis B viruses
First discovered in 1977, hepatitis D virus (formerly known as delta agent or delta virus) is one of the so-called „satellite viruses“, who are unable to reproduce independently (infectious diseases). You need the help of other viruses. In the case of hepatitis B infection, the helper is hepatitis B virus whose surface protein (HBsAg) needs the hepatitis D virus to multiply. Thus, the hepatitis D viruses use the envelope of the helper viruses to transport their own unique RNA of only 1,700 nucleotides into the liver cell of the host. Therefore, only people with hepatitis D who are simultaneously infected with hepatitis B can get sick. A hepatitis B vaccine thus also protects against hepatitis D. In the clinical picture, hepatitis D, in contrast to hepatitis B, is characterized by a particularly severe course of the disease, which can rapidly lead to liver cirrhosis or carcinomas as chronic hepatitis progresses, the MHH doctors emphasized.

Ten million people suffer from hepatitis D worldwide
MHH researchers warn that hepatitis D is not as rare as it is often claimed. For example, hepatitis D is relatively widespread in the Mediterranean, Africa, the Middle East and South America. Altogether, at least ten million people worldwide suffer from hepatitis D infection, and about 30,000 people are currently living in Germany, with migrants being particularly affected, the experts explained. Furthermore, a MHH press release states that more people die of hepatitis D annually in Germany than of AIDS and HIV-related diseases. However, only seven cases of hepatitis D were reported to the Robert Koch Institute in Germany in 2009. Regardless of the diseases in Germany, however, effective therapy, especially with regard to worldwide hepatitis D infections, would be a considerable success in any case. Like hepatitis B, hepatitis D is transmitted mainly through sexual intercourse and the use of infected needles. However, contaminated blood products, syringes, tattoo or acupuncture needles may also be considered as sources of infection in rare cases.

Peginterferon therapy shows success in hepatitis-D
The multi-center study on hepatitis D therapy conducted by Manns and Wedemeyer has involved not only 15 German centers but also Turkish and Greek clinics. The study randomized 90 hepatitis D patients into three groups, with one group receiving peginterferon alfa-2a and adefovir for one year, another with peginterferon alfa-2a plus placebo and the last one adefovir alone. The researchers were able to determine that at the end of therapy with peginterferon alfa-2a plus adefovir, 23 percent of the study participants were HDV-RNA-negative, meaning that no more hepatitis D viruses could be detected. In the treatment with peginterferon alfa-2a plus placebo, this was the case in 24 percent of study participants. The test results were also 24 weeks after the end of therapy still negative, which, according to the current understanding of a cure of viral infection is equivalent, the researchers said in their release. On the other hand, monotherapy with adefovir was ineffective, viral RNA concentrations could not be lowered, and no patient was HDV-RNA negative at the end of therapy, the researchers report.

Permanent cure of hepatitis D possible?
Although adefovir is not needed to eradicate the hepatitis D virus, the researchers still see a positive effect. Because adefovir promotes the cure of always coexistent hepatitis B. Thus, a significant decline in hepatitis B virus had been observed when peginterferon was used together with adefovir, the researchers said the MHH. Successes in the treatment of hepatitis D with peginterferon have already been achieved in the past, however, the viruses always increased again after the end of therapy. However, this does not seem to be the case with the peginterferon treatment now being used. However, the normalization of alanine aminotransferase required for a recognized cure of hepatitis in addition to a negative virus detection could be detected only in 7 percent of patients, which raises little doubt on the long-term success of therapy with peginterferon alfa-2a. However, those affected do not have many options anyway, as other therapies, such as the treatment with nucleoside and nucleotide analogues used in hepatitis B, do not work in a hepatitis D infection. (Fp)

Also read:
Hepatitis C: virus-free even without interferon
New drug against hepatitis C discovered

Image: Viktor Mildenberger