Researchers discovered efficient hepatitis D therapy
Scientists have discovered an effective hepatitis D therapy that can heal a hepatitis D infection in a quarter of cases.
The treatment with peginterferon alfa-2a, which has already been used to treat hepatitis B and C, also has an effect on hepatitis D, explained the researchers in the “Hep-Net International Delta Hepatitis Interventional Trial” (HIDIT) study group led by Michael Manns and Heiner Wedemeyer von the Hannover Medical School (MHH) in the current edition of the New England Journal of Medicine. Basically, treatment with peginterferon alfa-2a for hepatitis is an effective therapy, Wedemeyer and Manns emphasized.
Hepatitis D virus uses the shell of the hepatitis B virus The hepatitis D virus, which was first discovered in 1977 (formerly known as the delta agent or delta virus), is one of the so-called “satellite viruses” that are unable to do so to reproduce independently (infectious diseases). You need the help of other viruses. In the case of a hepatitis B infection, the helpers are hepatitis B viruses, whose surface protein (HBsAg) the hepatitis D viruses need to reproduce. The hepatitis D viruses use the envelope of the helper viruses to transport their own RNA, which contains only 1,700 nucleotides, into the host's liver cell. Therefore, only people who are infected with hepatitis B can develop hepatitis D. A hepatitis B vaccination thus also protects against hepatitis D. In contrast to hepatitis B, hepatitis D is characterized by a particularly severe course of the disease, which can quickly lead to liver cirrhosis or carcinoma if chronic hepatitis progresses, the MHH doctors emphasized .
Ten million people worldwide suffer from hepatitis D The MHH researchers warn that hepatitis D diseases are not as rare as is often claimed. According to them, hepatitis D is relatively widespread in the Mediterranean, Africa, the Middle East and South America. A total of at least ten million people worldwide suffer from hepatitis D infection and around 30,000 people are currently living in Germany, with migrants being particularly often affected, the experts said. Furthermore, a MHH press release states that currently more people die from hepatitis D in Germany than from AIDS and HIV-related diseases. However, only seven hepatitis D diseases were reported to the Robert Koch Institute in Germany in 2009. Regardless of the illnesses in Germany, efficient therapy would be a significant success in any case, especially with a view to worldwide hepatitis D infections. Like hepatitis B, hepatitis D is mainly transmitted through sexual intercourse and the use of infected needles. However, in rare cases, contaminated blood, syringes, tattoo or acupuncture needles are also possible sources of infection.
Peginterferon therapy shows success with hepatitis D In addition to 15 German centers, Turkish and Greek clinics also took part in the multicentre study on hepatitis D therapy conducted by Manns and Wedemeyer. In the study, 90 hepatitis D patients were randomly divided into three groups, one group being treated with peginterferon alfa-2a and the active substance adefovir for one year, another with peginterferon alfa-2a plus placebo and the last with adefovir only. 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, which means that hepatitis D viruses could no longer be detected. This was the case for 24 percent of the study participants when treated with peginterferon alfa-2a plus placebo. The test results were still negative 24 weeks after the end of therapy, which according to the current understanding equates to a cure for the virus infection, the researchers explained in the context of their publication. Monotherapy with adefovir, on the other hand, had proven to be ineffective, the virus RNA concentrations could not be reduced and no patient was HDV-RNA negative at the end of the therapy, the scientists report.
Permanent cure for hepatitis D possible? Although adefovir is not needed to eliminate the hepatitis D virus according to the study results, the researchers still see a positive effect. Because adefovir promotes the cure of the hepatitis B that is always present at the same time. A significant decrease in the hepatitis B virus was observed when peginterferon was used together with adefovir, the MHH researchers explained. Successes in the treatment of hepatitis D with peginterferon have already been achieved in the past, but the viruses always appeared again after the end of therapy. However, this does not seem to be the case with the peginterferon treatment now used. However, in addition to negative virus detection, the normalization of alanine aminotransferase required for a recognized cure for hepatitis could only be demonstrated in 7 percent of the patients, which raises slight doubts about the long-term success of peginterferon alfa-2a therapy. However, those affected do not have many options anyway, since other therapies, such as the treatment with hepatitis B with nucleoside and nucleotide analogues, do not work for hepatitis D infection. (fp)
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