Hepatology

Biography

Biography: Raffaella Romeo

Abstract

Chronic HDV infection has lately regained clinical importance because of the evidence of increasing prevalence in Western countries. Even though a systematic population’s screening is still not performed, main areas of prevalence are the Mediterranean basin, the Middle-East, Central and Northern-Asia, West and Central-Africa, the Amazonian basin, Northern South-America and the Asia-Pacific region. It is estimated a global burden of about 20 million cases worldwide. Epidemiological studies on genotypes distribution have demonstrated that different clinical courses may rely upon the presence of more virulent genotypes. Progressive forms of infection are reported from Far-East and South-America, where genotypes 2 and 3, respectively, are endemic. Genotype 1 is present worldwide associated to disease with variable course. Genotype 4, typical in the Far East, is characterised by a mild hepatitis. Genotypes 5-8, described in West and Central Africa, are still poorly studied, in terms of clinical course. The different clinical course determined by genotypes may depend upon different virion assembly efficiency as well as RNA replication fitness. Cirrhosis occurs within few years from HDV infection in about two thirds of cases, and there is a three-fold higher risk of progression to cirrhosis as compared to patients with chronic HBV mono infection only. Treatment of chronic HDV infection is difficult. The ideal drug would be able of inducing HDV clearance but also HBV clearance. Several attempts have been made with various drugs (IFN, PegIFN, Ribavirin, Lamivudine, Adefovir, Tenofovir) alone or in combination, with disappointing results. Attempts on looking for new antiviral compounds are currently ongoing.