{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T19:53:38Z","timestamp":1777924418401,"version":"3.51.4"},"reference-count":21,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,3,13]],"date-time":"2022-03-13T00:00:00Z","timestamp":1647129600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>In 1977 the viral Delta agent was discovered and subsequently characterized as the hepatitis Delta virus (HDV). HDV infection is associated with HBV infection since the defective HDV needs HBV to infect and replicate in the liver. Even if not a frequent cause of chronic liver disease, HDV infection is responsible for an aggressive progression of hepatitis towards advanced liver disease. At present, no FDA approved treatment exists for this specific form of hepatitis. Interferon alfa has been recommended as off-label therapy by major scientific societies (AASLD, EASL and APASL) and has proved effective in about one quarter of patients. In recent years, new therapeutic approaches have been studied, and EMA has approved a new drug (bulevirtide) for Delta hepatitis. In this review, we encompass the 45-year journey of managing Delta hepatitis and address the most recent developments in treating this severe and aggressive liver disease.<\/jats:p>","DOI":"10.3390\/jcm11061587","type":"journal-article","created":{"date-parts":[[2022,3,13]],"date-time":"2022-03-13T22:29:43Z","timestamp":1647210583000},"page":"1587","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Management of Delta Hepatitis 45 Years after the Discovery of HDV"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4181-795X","authenticated-orcid":false,"given":"Stefano","family":"Brillanti","sequence":"first","affiliation":[{"name":"Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1136\/gut.18.12.997","article-title":"Immunofluorescence detection of new antigen-antibody system (\u03b4\/anti-\u03b4) associated to hepatitis B virus in liver and in serum of HBsAg carriers","volume":"18","author":"Rizzetto","year":"1977","journal-title":"Gut"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/S0168-8278(85)80766-2","article-title":"Delta hepatitis\u2014Present status","volume":"1","author":"Rizzetto","year":"1985","journal-title":"J. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1782","DOI":"10.1136\/gutjnl-2020-323888","article-title":"Hepatitis D virus in 2021: Virology, immunology and new treatment approaches for a difficult-to-treat disease","volume":"70","author":"Urban","year":"2021","journal-title":"Gut"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.1053\/j.gastro.2009.01.052","article-title":"A 28-Year Study of the Course of Hepatitis \u0394 Infection: A Risk Factor for Cirrhosis and Hepatocellular Carcinoma","volume":"136","author":"Romeo","year":"2009","journal-title":"Gastroenterology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1016\/j.jhep.2018.12.022","article-title":"Treating chronic hepatitis delta: The need for surrogate markers of treatment efficacy","volume":"70","author":"Yurdaydin","year":"2019","journal-title":"J. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1056\/NEJM199401133300202","article-title":"Treatment of chronic hepatitis D with interferon alfa-2a","volume":"330","author":"Farci","year":"1994","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1740","DOI":"10.1053\/j.gastro.2004.03.017","article-title":"Long-term benefit of interferon \u03b1 therapy of chronic hepatitis D: Regression of advanced hepatic fibrosis","volume":"126","author":"Farci","year":"2004","journal-title":"Gastroenterology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"104995","DOI":"10.1016\/j.antiviral.2020.104995","article-title":"Effectiveness of pegylated interferon monotherapy in the treatment of chronic hepatitis D virus infection: A meta-analysis","volume":"185","author":"Abdrakhman","year":"2021","journal-title":"Antivir. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1111\/jvh.13366","article-title":"Ten-year follow-up of a randomized controlled clinical trial in chronic hepatitis delta","volume":"27","author":"Wranke","year":"2020","journal-title":"J. Viral Hepat."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1056\/NEJMoa0912696","article-title":"Peginterferon plus Adefovir versus Either Drug Alone for Hepatitis Delta","volume":"364","author":"Wedemeyer","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/S1473-3099(18)30663-7","article-title":"Peginterferon alfa-2a plus tenofovir disoproxil fumarate for hepatitis D (HIDIT-II): A randomized, placebo controlled, phase 2 trial","volume":"19","author":"Wedemeyer","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1111\/liv.14838","article-title":"New therapies for hepatitis delta virus infection","volume":"41","author":"Loureiro","year":"2021","journal-title":"Liver Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1016\/S1473-3099(15)00074-2","article-title":"Oral prenylation inhibition with lonafarnib in chronic hepatitis D infection: A proof-of-concept randomized, double-blind, placebo-controlled phase 2A trial","volume":"15","author":"Koh","year":"2015","journal-title":"Lancet Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1002\/hep.29658","article-title":"Optimizing lonafarnib treatment for the management of chronic delta hepatitis: The LOWR HDV-1 study","volume":"67","author":"Yurdaydin","year":"2018","journal-title":"Hepatology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1016\/S2468-1253(17)30288-1","article-title":"Safety and efficacy of REP 2139 and pegylated interferon alfa-2a for treatment-naive patients with chronic hepatitis B virus and hepatitis D virus coinfection (REP 301 and REP 301-LTF): A non-randomized, open-label, phase 2 trial","volume":"2","author":"Bazinet","year":"2017","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1016\/j.jhep.2016.04.016","article-title":"Treatment of chronic hepatitis D with the entry inhibitor myrcludex B: First results of a phase Ib\/IIa study","volume":"65","author":"Bogomolov","year":"2016","journal-title":"J. Hepatol."},{"key":"ref_17","first-page":"S205","article-title":"Safety and efficacy of bulevirtide monotherapy and in combination with Peginterferon alfa-2a in patients with chronic hepatitis delta: 24 weeks interim data of MYR204 Phase 2b study","volume":"75","author":"Asselah","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_18","first-page":"S294","article-title":"Bulevirtide monotherapy at low and high dose in patients with chronic hepatitis delta: 24 weeks interim data of the phase 3 MYR301 study","volume":"75","author":"Wedemeyer","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_19","first-page":"16A","article-title":"Safety and efficacy of 2mg bulevirtide in patients with chronic HBV\/HDV coinfection. First real-world results (French Early Access Program)","volume":"74","author":"Guyader","year":"2021","journal-title":"Hepatology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/j.jhep.2021.10.012","article-title":"Safety and effectiveness of up to 3 years\u2019 bulevirtide monotherapy in patients with HDV-related cirrhosis","volume":"76","author":"Loglio","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.jhep.2021.03.025","article-title":"Assembly and infection efficacy of hepatitis B virus surface protein exchanges in 8 hepatitis D virus genotype isolates","volume":"75","author":"Wang","year":"2021","journal-title":"J. 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