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/hdvfaq.htm Worldwide, the number of HDV infections has decreased since the 1980s, due mainly to a successful global HBV vaccination program.[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 immunization with hepatitis B immune globulin or via active immunization with a hepatitis B vaccine. For details of US immunization 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 reinfection can be prevented. Current regimens using hepatitis B immune globulin and nucleoside/nucleotide analogs are very effective in preventing HBV infection, with some centers in the US using only hepatitis B immune globulin short-term. However, a longer duration of hepatitis B immune globulin 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 immune globulin and nucleoside/nucleotide analogs 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 [60]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 immune globulin, 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 counseling 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 analog (with or without hepatitis B immune globulin) in all HBsAg-positive patients undergoing liver transplantation, regardless of pretransplant hepatitis B e antigen status or HBV DNA level. An individualized approach to the use of hepatitis B immune globulin 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.