Chronic hepatitis B with delta agent
Last reviewed: 23.04.2024
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Chronic hepatitis B with delta-agent occurs in most cases heavier than uncomplicated delta virus. There are data indicating that the factors of the virus (genotype), possibly, largely determine the course of the disease. In general, unlike chronic hepatitis B and viral hepatitis C, in which at least 70-50% of patients live their lives without the formation of liver cirrhosis, in 100% of patients with chronic viral hepatitis D within 15-30 years from the time of infection of liver cirrhosis inevitably develops in the absence of treatment. Further, the 10-year survival rate is 58% for asymptomatic liver cirrhosis and 40% for clinically pronounced cirrhosis. On average, 15% of patients experience slowly progressing course (30 years or more before cirrhosis), in 5-10% of patients, on the contrary, the disease quickly (from several months to two years) progresses to cirrhosis. Clinical manifestations of chronic hepatitis delta vary in a wide range - from asymptomatic current to clinically pronounced, active hepatitis with an abundance of complaints, disability and frequent exacerbations leading to hospitalization. Often, 1-2 years after superinfection, the patient begins to feel weakness, reduced efficiency. Possible sexual disorders in men and menstrual cycle disorders in women. There is a feeling of heaviness in the right hypochondrium, tolerance to alcohol, food loads decreases, the patient notes weight loss. Progression of the above complaints causes the patient to see a doctor and when examined and laboratory tests reveal hepatosplenomegaly, liver tightening, thrombocytopenia and hyperfermentemia (5-10 norms).
[Treatment
The only drug that reduces the level of cytolysis and slows the progression of the disease with cirrhosis of the liver is interferon alfa. High doses of interferon (9-10 million units) 3 times a week or the use of pegylated interferon alfa-2 make it possible to achieve a persistent biochemical response to treatment. The most productive treatment is during the first year from superinfection. Despite the normalization of transferase activity against the background of treatment, as a rule, after the abolition of therapy in most patients, according to biochemical studies, an acute event is recorded. A stable response to treatment is observed only in 10-15% of patients. The cases of seroconversion of HBsAg / anti-HBs, which are treated as a cure, are extremely rare. Nucleoside analogues (ribavirin, lamivudine) are ineffective.