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It is a defective virus, enveloped in the hepatitis B virus (HBV) surface proteins and requires HBV to gain access to the hepatocyte and spread within the host.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The estimated prevalence of HDV in Spain is less than 5% of chronic HBV infections.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> HDV superinfection in patients with chronic hepatitis B is characterised by a higher severity of liver disease, a higher incidence of liver cirrhosis and a higher risk of developing hepatocellular carcinoma compared to those observed in patients with isolated chronic hepatitis B.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 41-year-old male, asymptomatic, former injecting drug user, referred to the hepatology department of our centre due to the casual finding of positive serologies for HBV (HBsAg positive and AbHBe positive) and hepatitis C virus (HCV) (HCV-Ab positive). A complete serological study with HBV and HDV viral load, abdominal ultrasound and transient elastography were requested at the initial visit. Initial serology showed: HIV 1 and 2 antibodies negative; HBsAg positive, HBeAg negative, HBV-DNA 146 IU/mL; anti-HDV antibodies positive; anti-HCV antibodies positive with undetectable HCV-RNA. Abdominal ultrasound with signs of chronic liver disease without ultrasound evidence of portal hypertension (enlarged caudate lobe 36 mm, with heterogeneous parenchymal echogenicity) with transient elastography showing significant fibrosis (11.9 kPa) corresponding to a stage F3 fibrosis. Based on these findings, he was diagnosed with past hepatitis C (HCV-positive and HCV-RNA negative), HBeAg-negative chronic hepatitis B and HDV superinfection. After confirming the presence of HDV viral load and elevated transaminases (AST 204 U/L, ALT 287 U/L) treatment was started with pegylated interferon (PEG-IFN) 180 µg/week with transaminases returning to normal levels (AST 53 U/L, ALT 49 U/L), clearance of HBV-DNA and HDV-RNA at the completion of the 48-week cycle. At one year follow-up, the patient presented with increased transaminases (AST 100 U/L, ALT 117 U/L) in the context of chronic hepatitis delta recurrence (HDV-RNA positive), so tenofovir 245 mg/24 h was started. After approximately two and a half years of treatment with tenofovir, the patient was asymptomatic and had achieved clearance of HDV, HBV and HBV surface antigen (HBsAg) viral loads compatible with functional cure of chronic hepatitis B and HDV superinfection.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Currently the only treatment indicated for chronic hepatitis delta is PEG-IFN for 48 weeks, with virological response in approximately 25% of patients<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>. The use of nucleos(t)ide analogues or their combination with PEG-IFN is not routinely recommended. There is evidence of response to tenofovir in a patient who was unable to complete treatment with PEG-IFN due to its toxicity, with sustained HDV-RNA and HBsAg clearance after 2 years with tenofovir.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Soriano et al. demonstrated the potential benefit of tenofovir treatment in chronic hepatitis delta in 19 HIV patients co-infected with HBV and HDV, achieving clearance of HDV-RNA in more than half of the patients and of HBsAg in 3 of them.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> As a novelty, this is the first case described of a patient who, after achieving a virological response with PEG-IFN, had a recurrence that could be rescued with tenofovir, achieving a sustained virological response and HBsAg clearance. Currently, the only approved treatment is PEG-IFN, with low virological response rates and not without complications due to its side effects that limit its use in routine clinical practice. While awaiting the marketing of bulevirtide,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> the first drug targeting chronic hepatitis delta that will allow the use of interferon-free treatment regimens, tenofovir could be an option in patients who are non-responders or those with contraindications to PEG-IFN, although more evidence is needed for its use.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis D virus in 2021: virology, immunology and new treatment approaches for a difficult-to-treat disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Urban" 1 => "C. 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Soriano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MEG.0000000000001163" "Revista" => array:6 [ "tituloSerie" => "Eur J Gastroenterol Hepatol" "fecha" => "2018" "volumen" => "30" "paginaInicial" => "1060" "paginaFinal" => "1062" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29742524" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consensus document of the Spanish Association for Study of the Liver on the treatment of hepatitis B virus infection (2020) [Article in English, Spanish]" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Rodríguez" 1 => "M. Buti" 2 => "R. Esteban" 3 => "S. Lens" 4 => "M. Prieto" 5 => "E. Suárez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.gastrohep.2020.03.011" "Revista" => array:6 [ "tituloSerie" => "Gastroenterol Hepatol" "fecha" => "2020" "volumen" => "43" "paginaInicial" => "559" "paginaFinal" => "887" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32778356" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "First report of successful clearance of hepatitis B and D coinfection with tenofovir monotherapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. James" 1 => "P. Sidhu" 2 => "M. Raza" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.27446" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2015" "volumen" => "62" "paginaInicial" => "317" "paginaFinal" => "318" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25234819" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of prolonged tenofovir therapy on Hepatitis delta in HIV-infected patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Soriano" 1 => "E. Vispo" 2 => "R. Sierra-Enguita" 3 => "C. De Mendoza" 4 => "J.V. Fernández-Montero" 5 => "P. Labarga" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/QAD.0000000000000417" "Revista" => array:6 [ "tituloSerie" => "Aids" "fecha" => "2014" "volumen" => "28" "paginaInicial" => "2389" "paginaFinal" => "2394" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25111082" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015900000005/v1_202209020725/S2387020622003813/v1_202209020725/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015900000005/v1_202209020725/S2387020622003813/v1_202209020725/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020622003813?idApp=UINPBA00004N" ]
