Hepatitis delta and HIV infection

Hepatitis delta is the most severe of all chronic viral infections of the liver. Its agent, the hepatitis delta virus (HDV), is unique in many aspects. Because of similar transmission pathways, triple infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), and HDV occurs frequently in intravenous drug users. The addition of HDV to an HIV/HBV coinfection is associated with a particularly aggressive course of liver disease, frequently leading to cirrhosis, decompensation, and death. Thus, screening for antibodies against HDV should be mandatory in all HBsAg-positive/HIV-positive patients. There is no specific treatment for HDV. The only therapeutic options currently available are long-duration interferon regimens, which are effective in <30% of the patients. Additionally, long-term treatment with HBV polymerase inhibitors as part of antiretroviral treatment may lower HBsAg- and HDV-ribonucleic acid levels in some patients. Early initiation of anti-HIV therapy seems to be reasonable in patients with hepatitis delta - even though controlled studies are not available.