Modern aspects of anti-viral therapy for hepatitis D

Viral hepatitis D (HDV infection) worsens the prognosis of HBV infection course in 80-90% of cases, accelerating fibrosis and leading to liver cirrhosis or hepatocellular carcinoma. Hepatitis D affects at least 125 000 people in Russia, and in the world, according to rough estimates, there are 15–20 million patients. The main measures to combat hepatitis D can be attributed to widespread scheduled vaccination against hepatitis B and the appointment of effective etiotropic therapy. A detailed study of the hepatitis D virus genome structure and its replication cycle allows the development of a number of drugs that target and block key mechanisms of the virus life cycle. This review provides a brief characterization of hepatitis D virus, its genome structure, key processes of its life cycle and mechanisms of genetic information realization. The review considers the main potential targets for targeted antiviral therapy of HDV infection and describes specific drugs (bulevirtide, lonafarnib, nucleic acid polymers). The review describes the mechanism of action of bulevirtide, which according to the current national clinical guidelines is a key element of antiviral therapy as monotherapy or in combination with pegylated interferons. Promising drugs affecting the processes of synthesis and post-translational modification of HDAg or reducing the production of surface proteins of hepatitis B virus are also considered. Further efforts are needed to develop safe, effective and cost-effective drugs against hepatitis D to ensure that treatment is widely available to those who desperately need it. Therefore, it is important that the life cycle of the hepatitis D virus be studied further, in greater detail, in order to develop highly effective antiviral drugs.