HDV

Question 1

Which Hepatitis virus is considered the most aggressive

Answer 1

HDV

Question 2

Where and how does HDV replicate?

Answer 2

In the cell nucleus. It utilises the host RNA polymerase II to replicate via double rolling circle RNA synthesis

Encodes a single structural protein Small protein for viral replication and Large protein (promotes packaging of mature virions)

C-terminus: facilitated by an isoprenoid prosthetic side chain covalently bound to its C-terminus

Question 3

percentage that have HDV RNA detected if they have delta serology

Answer 3

60% (as per EASL guidelines)

HDV RNA serum levels may fluctuate overtime, becoming temporarily undetectable; therefore, the definition of HDV infection status cannot be based on a single determination and requires repeated tests (at least two) 3 to 6 months apart. (can also clear it, so need multiple tests to confirm either clearance or fluctuations)

HBsAg serum levels in untreated patients with CHD showed wider fluctuations than in untreated monoinfected patients with CHB.

Question 4

Duration of ifn treatment for delta

Answer 4

48 weeks

Note do not give interferon in decompensated cirrhosis, auto-imunity (ie those with LKM antibodies)

Predictors of response are: HDV genotype (5)
low levels of RNA and hep b surfcae)

Question 5

Indixations for TDF therapy in delta

Answer 5

HBV DNA over 2000
Cirrhosis