Resolution of chronic hepatitis Delta after 1 year of combined therapy with pegylated interferon, tenofovir and emtricitabine.
BACKGROUND
Hepatitis Delta virus (HDV) Infection has a worldwide distribution, with approximately 20 millions infected persons. Interferon (IFN) is the only approved drug for the treatment of HDV infection which is still a difficult to treat disease.


OBJECTIVE
To report a successful treatment of a patient with a chronic severe hepatitis Delta using combination therapy with Pegylated interferon (PegIFN), Tenofovir disoproxil fumarate (TDF) and Emtricitabine (FTC).


METHODS
The patient, a 47 years -old male patient, originating from Dagestan (East Asia), suffered of chronic hepatitis Delta infection. The patient was HBsAg, HBeAg, and anti-Delta Ab (IgG) positive. Serum HBV-DNA level was elevated (more than 9 log UI/mL). Serum HDV-RNA level was up to 5.6 log (copies/ml). Genotypes HBV/D and HDV-1 were demonstrated. The liver histology revealed chronic active hepatitis (Metavir score: A2F2). The treatment was started with PegIFN (180 microg/week) for two months and then TDF (300 mg/day) (combined later with FTC) was added.


RESULTS
Sustained response was obtained after 10 months of treatment and was accompanied by the clearance of serum hepatitis B virus surface antigen with seroconversion to anti-HBs.


CONCLUSIONS
This case report suggests that Delta infection may co-exist with high replicative HBV infection and that combination therapy with PegIFN and nucleoside/tide analogues seems to be more effective than IFN alone. Given that only a single case is reported, further studies including more patients are warranted.
Mansour
Wael
W
Laboratoire HIFIH UPRES EA 3859, Faculté de Médecine d'Angers, France.
Ducancelle
Alexandra
A
Le Gal
Frédéric
F
Le Guillou-Guillemette
Hélène
H
Abgueguen
Pierre
P
Pivert
Adeline
A
Calès
Paul
P
Gordien
Emmanuel
E
Lunel
Françoise
F
D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000914:Antibodies, Viral / Q000097:blood; D000998:Antiviral Agents / Q000008:administration & dosage*; D004279:DNA, Viral / Q000097:blood; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D004359:Drug Therapy, Combination; D000068679:Emtricitabine; D006509:Hepatitis B / Q000235:genetics; D019701:Hepatitis D, Chronic / Q000097:blood / Q000188:drug therapy*; D003698:Hepatitis Delta Virus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000008:administration & dosage*; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D012367:RNA, Viral / Q000097:blood; D011994:Recombinant Proteins; D000068698:Tenofovir; D016896:Treatment Outcome
D000914:Antibodies, Viral; D000998:Antiviral Agents; D004279:DNA, Viral; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D063065:Organophosphonates; D012367:RNA, Viral; D011994:Recombinant Proteins; D003841:Deoxycytidine; D011092:Polyethylene Glycols; D000068698:Tenofovir; D000068679:Emtricitabine; D000225:Adenine; C100416:peginterferon alfa-2a