{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T06:30:18Z","timestamp":1791268218955,"version":"4.1.0"},"reference-count":15,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2015,1,21]],"date-time":"2015-01-21T00:00:00Z","timestamp":1421798400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100012553","name":"Chang Gung Memorial Hospital","doi-asserted-by":"crossref","award":["CLRPG3C0011"],"award-info":[{"award-number":["CLRPG3C0011"]}],"id":[{"id":"10.13039\/100012553","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Medical Virology"],"published-print":{"date-parts":[[2015,4]]},"abstract":"<jats:sec><jats:label\/><jats:p>A chronic lymphocytic leukemia patient had achieved complete virological suppression of hepatitis B virus (HBV) by oral antiviral therapy. Unexpectedly, fulminant hepatitis D virus (HDV) reactivation occurred, resulting in mortality. Cloning and sequence analysis identified a novel large fragment HDV deletion mutant containing only 69% of the standard genome. Reverse transcription\u2010PCR assay revealed persistence of this mutant with variations of the wild\u2010type\u2010to\u2010mutant ratios during the clinical course. Serum samples from 405 patients with chronic hepatitis B were then submitted for HDV RNA analysis. Of them, 20 (4.9%) were positive for HDV RNA and 5 HDV RNA large fragment deletions were identified in three patients, all under entecavir treatment. Two of them suffered from acute hepatitis exacerbations leading to liver failure while the third had repeated hepatitis flares. The peak bilirubin levels in these three patients were significantly higher than the others without large fragment deletions (<jats:italic>P\u2009<\/jats:italic>=\u20090.003). The deleted regions (527\u2013702 bases) encompassed two ribozyme domains as well as part of the hepatitis D antigen (HDAg) reading frame. In conclusion, exacerbations of hepatitis D could occur, leading to fulminant hepatitis, even after complete virological suppression of HBV. Large fragment HDV RNA deletions were identified in some hepatitis D patients who were treated with entecavir but still experiencing severe hepatitis. <jats:bold><jats:italic>J. Med. Virol. 87:634\u2013641, 2015<\/jats:italic>.<\/jats:bold> \u00a9 2015 Wiley Periodicals, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jmv.24107","type":"journal-article","created":{"date-parts":[[2015,1,21]],"date-time":"2015-01-21T20:30:01Z","timestamp":1421872201000},"page":"634-641","source":"Crossref","is-referenced-by-count":5,"title":["Detection of hepatitis D virus RNA carrying large fragment deletions in patients with severe hepatitis B\/D receiving oral antiviral therapy"],"prefix":"10.1002","volume":"87","author":[{"given":"Chao\u2010Wei","family":"Hsu","sequence":"first","affiliation":[{"name":"Liver Research Center Department of Hepato\u2010Gastroenterology Chang Gung Memorial Hospital Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei","family":"Chao","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Immunology Chang Gung University College of Medicine Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi\u2010Cheng","family":"Chen","sequence":"additional","affiliation":[{"name":"Liver Research Center Department of Hepato\u2010Gastroenterology Chang Gung Memorial Hospital Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming\u2010Ling","family":"Chang","sequence":"additional","affiliation":[{"name":"Liver Research Center Department of Hepato\u2010Gastroenterology Chang Gung Memorial Hospital Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiu\u2010Feng","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Pathology Chang Gung Memorial Hospital Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chau\u2010Ting","family":"Yeh","sequence":"additional","affiliation":[{"name":"Liver Research Center Department of Hepato\u2010Gastroenterology Chang Gung Memorial Hospital Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,1,21]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hepres.2006.05.003"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2004.03.017"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)61931-9"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2012.05.002"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.510300217"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1261\/rna.7650904"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2005.02542.x"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.18.12.997"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-98-4-437"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2009.01.052"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21590"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0912696"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(95)90453-0"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v11.i11.1658"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1053\/jhep.2000.7296"}],"container-title":["Journal of Medical Virology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fjmv.24107","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jmv.24107","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T22:54:13Z","timestamp":1696460053000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jmv.24107"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,1,21]]},"references-count":15,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2015,4]]}},"alternative-id":["10.1002\/jmv.24107"],"URL":"https:\/\/doi.org\/10.1002\/jmv.24107","archive":["Portico"],"relation":{},"ISSN":["0146-6615","1096-9071"],"issn-type":[{"value":"0146-6615","type":"print"},{"value":"1096-9071","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,1,21]]}}}