Devil hepatitis D: an orphan disease or largely underdiagnosed?

Hepatotropic viruses can infect hepatocytes causing a host defence reaction and subsequently scaring of the liver—if the infection is not cleared. The threats of chronic viral hepatitis partially vanished due to the revolution of antiviral treatment options first for hepatitis B and more recently for hepatitis C. Persistent HCV infection can nowadays be cleared with direct acting antiviral agents leading to impressive improvements in the clinical long-term outcome with reduced incidences of hepatic decompensation and hepatocellular carcinoma. Similarly, durable suppression of HBV replication has been shown to prevent disease progression and even to normalise life expectancy unless hepatocellular carcinoma appears.1 Unfortunately, the scenario is completely different for hepatitis D virus (HDV) infection. Coinfection of HBsAg-positive individuals with HDV causes the most severe form of chronic viral hepatitis with earlier development of liver cirrhosis, higher incidence of hepatocellular carcinoma and increased liver-related and overall mortality.2 3

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