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An estimated 12 million people are infected by HDV worldwide.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To summarise the most relevant aspects of the molecular biology of HDV, and to discuss the latest understanding of the induced pathology, interactions with the immune system, as well as both approved and investigational treatment options.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>References for this review were identified through searches of <jats:styled-content style=\"fixed-case\">PubMed<\/jats:styled-content> with the terms \u201c<jats:styled-content style=\"fixed-case\">HDV<\/jats:styled-content>\u201d \u201cviral hepatitis\u201d \u201cco\u2010infection\u201d and \u201csuper\u2010infection,\u201d published between 1980 and October 2021<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The limited access to the HDV\u2010infected liver has hampered the investigation of the intrahepatic compartment and our understanding of the mechanisms of HDV pathogenesis. In the absence of standardised and sensitive diagnostic tools, HDV is often underdiagnosed and owing to its strong dependence on host cellular factors, the development of direct antiviral agents has been challenging. New therapeutic agents targeting different steps of the viral cycle have recently been investigated, among which bulevirtide (which was conditionally approved by EMA in July 2020) and lonafarnib; both drugs having received orphan drug designation from both the EMA and FDA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The HBV cure programme potentially offers a unique opportunity to enhance HDV treatment strategies. In addition, a more comprehensive analysis of the intrahepatic compartment is mandated to better understand any liver\u2010confined interaction of HDV with the host immune system.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.16807","type":"journal-article","created":{"date-parts":[[2022,3,16]],"date-time":"2022-03-16T07:42:27Z","timestamp":1647416547000},"page":"978-993","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Review article: emerging insights into the immunopathology, clinical and therapeutic aspects of hepatitis delta virus"],"prefix":"10.1111","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6373-2765","authenticated-orcid":false,"given":"Carla","family":"Usai","sequence":"first","affiliation":[{"name":"Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry Queen Mary University of London  London 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