Interferon in HDV infection

Treatment of chronic hepatitis D with thymus-derived polypeptide thymic humoral factor-gamma 2: a pilot study

BACKGROUND

Thymic humoral factor-gamma 2 is a thymus-derived synthetic octapeptide, shown to be effective in chronic hepatitis B virus infection; as the latter is needed to support hepatitis D virus, thymic humoral factor-gamma 2 may have a therapeutic role in hepatitis D.

AIM

To evaluate tolerability and efficacy of thymic humoral factor-gamma 2 in chronic hepatitis D.

METHODS

Intramuscular thymic humoral factor-gamma 2, 40 microg, was given for 15 consecutive days and twice weekly for 22 additional weeks to adult patients with chronic hepatitis D virus hepatitis.

RESULTS

A total of 11 patients (male/female 9/2, mean age 45.9 years] completed the treatment period, 10 the 6-month follow-up. At baseline, hepatitis D virus-RNA was positive in 8/11 (73%) patients. During treatment, hepatitis D virus-RNA became undetectable in 3/8 (37%), decreased in 1/8 (13%), remained unchanged in 4/8 (50%) and persisted undetectable in 3 patients, negative at baseline. During follow-up hepatitis D-viraemia relapsed in all patients but 2, one already negative at baseline. No changes in hepatitis B virus markers occurred. Mean serum alanine aminotransferase levels did not change significantly None of the patients reached normal serum alanine aminotransferase levels.

CONCLUSION

At the doses given, thymic humoral factor-gamma 2 has been of limited efficacy A possible role of thymic humoral factor-gamma 2 in the treatment of chronic hepatitis D requires further dose-finding studies and/or combination with other antivirals.

Hepatitis delta virus: the molecular basis of laboratory diagnosis

Infection with hepatitis delta virus (HDV), a satellite virus of hepatitis B virus (HBV), is associated with severe and sometimes fulminant hepatitis. The traditional methods for the diagnosis of HDV infection, such as detection of serum anti-HD antibodies, are sufficient for the clinical diagnosis of delta infection. However, such techniques lack the sensitivity and specificity required to more accurately characterize the nature of HDV infection and to assess the efficacy of therapies. Recent improvements in molecular techniques, such as HDV RNA hybridization and RT-PCR, have provided increased diagnostic precision and a more thorough understanding of the natural course of HDV infection. These advances have enhanced the clinician's ability to accurately evaluate the stage of HDV infection, response to therapy, and occurrence of reinfection after orthotopic liver transplant. This review focuses on the recent advances in the understanding of the molecular biology of HDV and in the laboratory diagnosis of HDV infection.

Development of antiviral therapy with alpha interferons: promises, false hopes and accomplishments

This overview describes the development of interferon therapy in four different types of viral diseases. (1) Upper respiratory infections: despite extensive efforts interferons have not found a place in the treatment of these very common diseases. (2) Herpes keratitis: alpha interferons are highly active in combination therapy, but have gained only very limited clinical use. (3) Papillomavirus infections: alpha interferons have been approved for the treatment of papillomavirus infections of skin and mucous membranes and are in fairly wide clinical use. (4) Chronic hepatitis B, C and D: alpha interferons have become the treatment of choice and are used very extensively worldwide. The four examples illustrate both the clinical potentials and the limitations of alpha interferons and give some guidelines for future work. The overall conclusion is that chronic viral diseases lend themselves to interferon therapy more readily than acute viral infections. The general trend is toward the use of interferons in combination therapy.