Hepatitis D – the most aggressive, but neglected chronic viral hepatitis
General Medicine, 2025, 27(2), 48-53.
R. Komitova1, L. Glomb2, A. Kevorkyan3
1 Department of Infectious Diseases, Parasitology, and Tropical Medicine, Medical University ‒ Plovdiv
2 Physician ‒ clinical virologist, member of the Expert Council for the medical specialty „Clinical Virology“ and the National Expert Specialized Medical College of the Bulgarian Medical Association
3 Department of Epidemiology and Disaster Medicine, Medical University ‒ Plovdiv
Abstract. Hepatitis D virus (HDV) is a satellite virus that coexists with hepatitis B (HBV) to replicate in the host cell and exert its pathogenicity. This effectively means that individuals with hepatitis D are always dually infected with HDV and HBV. HDV causes the most severe form of chronic viral hepatitis, with rapid progression to cirrhosis and liver failure. Despite the burden of HDV infection, screening for it remains inadequate. The development of selective antiviral drugs remains a challenge. For decades, pegylated interferon alpha (PEG INF) has been the only therapeutic option with suboptimal efficacy. In 2023, the European Medicines Agency approved the specific antiviral bulevirtide, an inhibitor of HDV entry into the hepatocyte. The publication reviews the epidemiology, clinical course, and therapy of HDV infection.
Key words: HDV, co-infection, superinfection