Chronische Hepatitis-B- und Hepatitis-D-Virusinfektion

Eine unbehandelte chronische Hepatitis-B-Virus-Infektion kann bis zur Leberzirrhose und zum hepatozellulären Karzinom fortschreiten, was durch eine rechtzeitige Diagnose und eine antivirale Therapie verhindert werden kann. Eine Heilung ist bisher aber in der Regel nicht möglich. Eine Koinfektion mit dem Hepatitis-D-Virus erhöht das Risiko einer Leberzirrhose. Auch für die Hepatitis D steht inzwischen eine effektive Therapie zur Verfügung.

Abstract

About 0,5% of the population in Germany has a chronic hepatitis B virus (HBV) infection. Untreated, chronic HBV infection can progress to liver cirrhosis and hepatocellular carcinoma (HCC). If diagnosed early, antiviral therapy can effectively prevent liver disease progression, but a cure is currently hardly achievable. About 5% of those chronically infected with HBV are also co-infected with the hepatitis D virus (HDV). HBV/HDV co-infection leads to liver cirrhosis in approximately 50% of patients within 5–10 years. Since 2020, the cell entry inhibitor bulevirtide is available as a specific therapy for HBV/HDV co-infection.

Schlüsselwörter

Hepatitis-B-Virus - Hepatitis-D-Virus - Therapie - antiviral - Entecavir - Tenofovir - Bulevirtid

Keywords

hepatitis B virus - hepatitis D virus - therapy - antiviral - entecavir - tenofovir - bulevirtide

• Literatur

• 1 Biallas R, Steffen G, Burdi S. et al. Anstieg der übermittelten Hepatitis-B-und Hepatitis-C-Fälle in Deutschland im Jahr 2022. Epid Bull 2023; 31: 3-16
• 2 Stockdale AJ, Kreuels B, Henrion MYR. et al. The global prevalence of hepatitis D virus infection: Systematic review and meta-analysis. J Hepatol 2020; 73: 523-532
• 3 European Association for the Study of the Liver (EASL). EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol 2017; 67: 370-398
• 4 Cornberg M, Sandmann L, Protzer U. et al. S3-Leitlinie der Deutschen Gesellschaft fur Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) zur Prophylaxe, Diagnostik und Therapie der Hepatitis-B-Virusinfektion (AWMF-Register-Nr. 021–11). Z Gastroenterol 2021; 59: 691-776
• 5 World Health Organization: Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection. 2024 Accessed June 22, 2024 at: https://www.who.int/publications/i/item/9789240090903
• 6 Hirode G, Choi HSJ, Chen CH. et al. Off-therapy response after nucleos(t)ide analogue withdrawal in patients with chronic hepatitis B: an international, multicenter, multiethnic cohort (RETRACT-B Study). Gastroenterology 2022; 162: 757-771 e754
• 7 Sonneveld MJ, Chiu SM, Park JY. et al. Probability of HBsAg loss after nucleo(s)tide analogue withdrawal depends on HBV genotype and viral antigen levels. J Hepatol 2022; 76: 1042-1050
• 8 Agarwal K, Lok J, Carey I. et al. A case of HBV-induced liver failure in the REEF-2 phase II trial: Implications for finite treatment strategies in HBV 'cure'. J Hepatol 2022; 77: 245-248
• 9 Daher D, Seif El Dahan K, Cano A. et al. Hepatocellular Carcinoma Surveillance Patterns and Outcomes in Patients With Cirrhosis. Clin Gastroenterol Hepatol 2024; 22: 295-304 e292
• 10 Neumann-Haefelin C. HCC-Surveillance bei Patienten mit chronischer Virushepatitis. Gastroenterologe 2021; 16: 450-454
• 11 Asselah T, Rizzetto M. Hepatitis D virus infection. N Engl J Med 2023; 389: 58-70
• 12 Sandmann L, Wedemeyer H. Interferon-based treatment of chronic hepatitis D. Liver Int 2023; 43: S69-79
• 13 Dietz-Fricke C, Tacke F, Zollner C. et al. Treating hepatitis D with bulevirtide – Real-world experience from 114 patients. JHEP Rep 2023; 5: 100686
• 14 Wedemeyer H, Aleman S, Brunetto M. et al. Efficacy and safety at 96 weeks of bulevirtide 2 mg or 10 mg monotherapy for chronic hepatitis D: results from an interim analysis of a phase 3 randomized study. J Hepatol 2023; 78: S57-58
• 15 Wedemeyer H, Aleman S, Brunetto MR. et al. A phase 3, randomized trial of bulevirtide in chronic hepatitis D. N Engl J Med 2023; 389: 22-32
• 16 Anolli MP, Degasperi E, Allweiss L. et al. A 3-year course of bulevirtide monotherapy may cure HDV infection in cirrhotics. J Hepatol 2023; 78: 876-880
• 17 Dietz-Fricke C, Degasperi E, Lampertico P. et al. Off-label bulevirtide monotherapy for chronic hepatitis D virus infection in patients with decompensated liver disease. J Hepatol 2023; 78: S10-S109
• 18 European Association for the Study of the Liver (EASL). EASL Clinical Practice Guidelines on hepatitis delta virus. J Hepatol 2023; 79: 433-460
• 19 Sandmann L, Berg T, Deterding K. et al. Addendum „Antivirale Therapie der chronischen Hepatitis-D-Virusinfektion“ zur S3-Leitlinie „Prophylaxe, Diagnostik und Therapie der Hepatitis-B-Virusinfektion“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) (AWMF-Registernummer 021–11). 2023
• 20 Degasperi E, Anolli MP, Lampertico P. Bulevirtide-based treatment strategies for chronic hepatitis delta: A review. J Viral Hepat 2023; 30: S26-32
• 21 Wedemeyer H, Schoneweis K, Bogomolov PO. et al. Final results of a multicenter, open-label phase 2 clinical trial (MYR203) to assess safety and efficacy of myrcludex B in combination with PEG-interferon alpha 2a in patients with chronic HBV/HDV co-infection. J Hepatol 2019; 70: E81-E81
• 22 Asselah T. Beyond bulevirtide: Alternative therapeutic options for the management of hepatitis delta virus. J Viral Hepat 2023; 30: S33-38
• 23 Roca Suarez AA, Batbold E, Bartosch B. et al. Emerging anti-HDV drugs and HBV cure strategies with anti-HDV activity. Liver Int 2023; 43: 87-95
• 24 Jeng WJ, Lok ASF. What will it take to cure hepatitis B?. Hepatol Commun 2023; 7: e0084