Chronic Hepatitis D—What Is Changing?

David Yardeni; Theo Heller; Christopher Koh


J Viral Hepat. 2022;29(4):240-251. 

In This Article

Abstract and Introduction


Hepatitis D virus (HDV) infection is a chronic viral disease of the liver that is still largely considered to be incurable due to lack of effective treatment options. Without treatment, the risk for the development of advanced liver disease, cirrhosis and hepatocellular carcinoma is significantly high. Currently, new therapeutic options are emerging out of ongoing phase 3 clinical trials, promising a new hope of cure for this devastating liver infection. Recently, bulevirtide, a first in its class HDV entry inhibitor, has received conditional authorization of use from the European Medicines Agency (EMA) and was also submitted for approval in the United States. Other novel therapeutic options in clincal trials include interferon lambda, the prenylation inhibitor lonafarnib and nucleic acidic polymers (NAPs). This review describes all recent advances and ongoing changes to the field of HDV therpaeutics.


Chronic infection of the liver by the hepatitis D virus (HDV) is considered an incurable disease that is currently without a United States (US) Food and Drug Administration (FDA)–approved therapy.[1] The combined properties of this defective satellite virus that requires the ever-essential co-infection with the hepatitis B virus (HBV) have managed to prevent significant advancement in therapeutic options for many years. This delay in therapy has unfortunately doomed many patients worldwide to the end points of chronic liver inflammation, which are hepatocellular carcinoma (HCC) and cirrhosis.[2]

In recent years, several new approaches to HDV therapy have been developed which for the first time bring hope that a long-lasting cure for this virus is within grasp. This review will focus on recent advances in these new approaches that aim to change this unacceptable reality of HDV infection.