Treatment of hepatitis delta virus genotype 3 infection with peg-interferon and entecavir

•The effects of therapy with pegylated interferon alpha 2a (PEG-IFN) were evaluated in patients with hepatitis delta virus genotype 3 (HDV-3) and these were correlated with a possible cure rate higher than expected.•The therapeutic protocol used in this study presented a satisfactory response level in terms of the proportion of treated subjects with a virological response.•HDV patients in the Amazon region can be treated with a combination of PEG-IFN and entecavir for 48 weeks, with a good chance of negative HDV RNA at week 24.•The results suggest that HDV-3 in the native population may be an ‘easy to treat’ variant compared to HDV-1.

SummaryObjectivesHepatitis delta virus (HDV) is recognized as the most pathogenic and infectious among the hepatotropic viruses. Studies on the treatment of HDV have predominantly included European patients and carriers of genotype 1 (HDV-1) in their clinical protocols. For the Amazon region, data show that infected individuals have mainly Native American ancestry and that >90% of HDV carriers have the genotype 3 (HDV-3). Thus combined therapy clinical protocols do not adequately address the treatment of these patients.MethodsA prospective, non-randomized study was conducted in which 22 patients received 180 μg of pegylated interferon alpha 2a (PEG-IFN) plus entecavir at a dose of 0.5 mg for 48 weeks, with a subsequent 24-week follow-up. Throughout treatment, the patients were monitored for biochemical responses and the kinetics of hepatitis B virus (HBV) and HDV viral loads.ResultsOf the 22 patients treated, 15 presented normal alanine aminotransferase values at the end of treatment (p = 0.002). At week 24 of treatment, 86.4% of the patients did not present detectable HDV-RNA; at week 48, the rate of negative patients increased to >95% and remained the same after 6 months. With regard to HBV, only two patients (9%) still presented detectable HBV genetic material at the end of treatment, suggesting the effectiveness of combined therapy in combating the two viruses.ConclusionsThese findings support the use of this effective therapeutic protocol for HDV-3 in patients of non-European ethnicity and suggest a possible ‘easy to treat’ variant when compared to HDV-1.