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Chronic hepatitis B with delta agent
Last reviewed: 07.07.2025
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Chronic hepatitis B with delta agent is more severe in most cases than hepatitis B uncomplicated by delta virus. There is evidence that viral factors (genotype) may 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 developing liver cirrhosis, 100% of patients with chronic viral hepatitis D inevitably develop liver cirrhosis within 15-30 years from the moment of infection in the absence of treatment. Then, the 10-year survival rate is 58% with asymptomatic liver cirrhosis and 40% with clinically expressed cirrhosis. On average, 15% of patients have a slowly progressive course (30 years or more before cirrhosis develops), while in 5-10% of patients, on the contrary, the disease quickly (from several months to two years) progresses to cirrhosis of the liver. Clinical manifestations of chronic hepatitis delta vary widely - from asymptomatic to clinically expressed, actively occurring hepatitis with an abundance of complaints, loss of ability to work and frequent exacerbations leading to hospitalization. Often, 1-2 years after superinfection, the patient begins to feel weakness, decreased performance. Sexual dysfunction in men and menstrual disorders in women are possible. A feeling of heaviness in the right hypochondrium appears, tolerance to alcohol and food loads decreases, the patient notes weight loss. The progression of the above complaints forces the patient to consult a doctor, and upon examination and laboratory testing, hepatosplenomegaly, liver compaction, thrombocytopenia and hyperfermentemia (5-10 normal) are revealed.
[ Treatment
The only drug that can reduce the level of cytolysis and slow the progression of the disease in liver cirrhosis is interferon alpha. High doses of interferon (9-10 million U) 3 times a week or the use of pegylated interferon alpha-2 can achieve a stable biochemical response to treatment. The most effective treatment is during the first year for superinfection. Despite the normalization of transferase activity during treatment, as a rule, after discontinuation of therapy, most patients experience an exacerbation, according to biochemical studies. A stable response to treatment is observed in only 10-15% of patients. Cases of HBsAg/anti-HBs seroconversion, which is interpreted as a cure, are extremely rare. Nucleoside analogues (ribavirin, lamivudine) are ineffective.