Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2024; 30(8): 799-805
Published online Feb 28, 2024. doi: 10.3748/wjg.v30.i8.799
Management of autoimmune hepatitis induced by hepatitis delta virus
Eleni Gigi, Vasileios Lagopoulos, Aris Liakos
Eleni Gigi, Hepatology Unit, The Second Internal Medicine Department, Aristotle University Medical School, Hippokrateio General Hospital, Thessaloniki 54642, Greece
Vasileios Lagopoulos, Department of Surgical, AHEPA General Hospital of Thessaloniki, Thessaloniki 54636, Greece
Aris Liakos, Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Hippokratio General Hospital, Aristotle University Thessaloniki, Thessaloniki 54642, Greece
Author contributions: Gigi E conceived the title, designed, and wrote the manuscript, and performed the final revision; Lagopoulos V contributed in the writing and the revision of the manuscript; Liakos A contributed in the writing and the revision of the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Eleni Gigi, MD, PhD, Academic Research, Assistant Professor, Hepatology Unit, The Second Internal Medicine Department, Aristotle University Medical School, Hippokrateio General Hospital, 49 Konstantinoupoleos, Thessaloniki 54642, Greece. elengigi@auth.gr
Received: December 7, 2023
Peer-review started: December 7, 2023
First decision: December 21, 2023
Revised: January 2, 2024
Accepted: January 30, 2024
Article in press: January 30, 2024
Published online: February 28, 2024
Abstract

Approximately 12-72 million people worldwide are co-infected with hepatitis B virus (HBV) and hepatitis delta virus (HDV). This concurrent infection can lead to several severe outcomes with hepatic disease, such as cirrhosis, fulminant hepatitis, and hepatocellular carcinoma, being the most common. Over the past few decades, a correlation between viral hepatitis and autoimmune diseases has been reported. Furthermore, autoantibodies have been detected in the serum of patients co-infected with HBV/HDV, and autoimmune features have been reported. However, to date, very few cases of clinically significant autoimmune hepatitis (AIH) have been reported in patients with HDV infection, mainly in those who have received treatment with pegylated interferon. Interestingly, there are some patients with HBV infection and AIH in whom HDV infection is unearthed after receiving treatment with immunosuppressants. Consequently, several questions remain unanswered with the challenge to distinguish whether it is autoimmune or “autoimmune-like” hepatitis being the most crucial. Second, it remains uncertain whether autoimmunity is induced by HBV or delta virus. Finally, we investigated whether the cause of AIH lies in the previous treatment of HDV with pegylated interferon. These pressing issues should be elucidated to clarify whether new antiviral treatments for HDV, such as Bulevirtide or immu-nosuppressive drugs, are more appropriate for the management of patients with HDV and AIH.

Keywords: Autoimmune hepatitis, Hepatitis delta virus, Bulevirtide, Prednisolone

Core Tip: There are some pressing issues that should be elucidated in order to clarify whether new antiviral treatments for hepatitis delta virus (HDV), such as Bulevirtide, or immunosuppressive drugs, are more appropriate for the management of patients with HDV and autoimmune hepatitis (AIH). Firstly, several questions remain unanswered with the challenge to distinguish whether it is autoimmune or “autoimmune-like” hepatitis being the most crucial. Secondly, it yet remains uncertain whether autoimmunity is induced by the hepatitis B virus or the Delta virus. Finally, if the cause of AIH lies on the previous treatment of HDV with pegylated interferon.