Hepatitis D

Since hepatitis D virus (HDV) requires the presence of hepatitis B virus (HBV) surface antigen to propagate, vaccination against HBV is the main strategy to prevent HDV infection.[12]Centers for Disease Control and Prevention. Hepatitis D questions and answers for health professionals. Jul 2024 [internet publication]. https://www.cdc.gov/hepatitis/hdv/index.htm Worldwide, the number of HDV infections has decreased since the 1980s, due mainly to a successful global HBV vaccination programme.[32]World Health Organization. Hepatitis D fact sheet. July 2023 [internet publication]. https://www.who.int/news-room/fact-sheets/detail/hepatitis-d ​ HDV vaccines have been developed in animal models with very limited success.[33]Aldabe R, Suárez-Amarán L, Usai C, et al. Animal models of chronic hepatitis delta virus infection host-virus immunologic interactions. Pathogens. 2015 Feb 12;4(1):46-65. https://www.doi.org/10.3390/pathogens4010046 http://www.ncbi.nlm.nih.gov/pubmed/25686091?tool=bestpractice.com

Primary prevention of HBV can be via passive immunisation with hepatitis B immunoglobulin or via active immunisation with a hepatitis B vaccine. For details of US immunisation schedules, consult the Advisory Committee on Immunization Practices (ACIP) guidelines. CDC: ​immunization schedules Opens in new window

Prevention of HDV infection in the allograft after liver transplantation is an important goal, although this typically does not occur if HBV re-infection can be prevented. Current regimens using hepatitis B immunoglobulin and nucleoside/nucleotide analogues are very effective in preventing HBV infection, with some centres in the US using only hepatitis B immunoglobulin short-term. However, a longer duration of hepatitis B immunoglobulin was associated with a lower risk of HBV reactivation in HDV-positive patients in the landmark EUROHEP study, and American Association for the Study of Liver Diseases (AASLD) guidelines suggest a combination of long-term hepatitis B immunoglobulin and nucleoside/nucleotide analogues to prevent HBV and HDV infection in the allograft.[2]Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018 Apr;67(4):1560-99. https://www.doi.org/10.1002/hep.29800 http://www.ncbi.nlm.nih.gov/pubmed/29405329?tool=bestpractice.com [59]Wedemeyer H, Schöneweis K, Bogomolov P, et al. Safety and efficacy of bulevirtide in combination with tenofovir disoproxil fumarate in patients with hepatitis B virus and hepatitis D virus coinfection (MYR202): a multicentre, randomised, parallel-group, open-label, phase 2 trial. Lancet Infect Dis. 2023 Jan;23(1):117-29. http://www.ncbi.nlm.nih.gov/pubmed/36113537?tool=bestpractice.com

Screen pregnant women for hepatitis B surface antigen (HBsAg).[2]Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018 Apr;67(4):1560-99. https://www.doi.org/10.1002/hep.29800 http://www.ncbi.nlm.nih.gov/pubmed/29405329?tool=bestpractice.com Pregnant women should also be encouraged to discuss the need for maternal antiviral therapy, as well as newborn hepatitis B vaccination and hepatitis B immunoglobulin, with their obstetrician to prevent mother-to-child transmission.[2]Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018 Apr;67(4):1560-99. https://www.doi.org/10.1002/hep.29800 http://www.ncbi.nlm.nih.gov/pubmed/29405329?tool=bestpractice.com

Healthcare workers with HBV infection who perform exposure-prone procedures should be advised to seek counselling and advice from an expert review panel, as antiviral prophylaxis may be recommended.[2]Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018 Apr;67(4):1560-99. https://www.doi.org/10.1002/hep.29800 http://www.ncbi.nlm.nih.gov/pubmed/29405329?tool=bestpractice.com

Initiate antiviral prophylaxis in patients with past HBV infection who are starting on immunosuppressive therapy in order to prevent HBV reactivation.

Initiate lifelong antiviral prophylaxis with a nucleoside/nucleotide analogue (with or without hepatitis B immunoglobulin) in all HBsAg-positive patients undergoing liver transplantation, regardless of pre-transplant hepatitis B e antigen status or HBV DNA level. An individualised approach to the use of hepatitis B immunoglobulin use is recommended.

Initiate long-term antiviral therapy in HBsAg-negative patients receiving livers from donors with evidence of past HBV infection (antibody to hepatitis B core antigen-positive) to prevent HBV reactivation.