Expert Point of View - Emerging Issues in Hepatitis D - Zaigham Abbas, MBBS, FCPS, FRCP, FRCPI, FACP, FACG, AGAF

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WORLD GASTROENTEROLOGY NEWS Official e-newsletter of the World Gastroenterology Organisation VOL. 21, ISSUE 2 JULY 2016 In this issue www.worldgastroenterology.org Intrahepatic Cholestasis of Pregnancy: Even Today a Puzzling Disease of Pregnancy Rodrigo Zapata MD, FAASLD Celiac Disease CAROLINA CIACCI, MD PETER GREEN, MD JULIO C. BAI, MD Zaigham Abbas, MBBS, FCPS, FRCP, FRCPI, FACP, FACG, AGAF Professor and Head, Department of Gastroenterology Ziauddin University Hospital Clifton Karachi, Pakistan Continued on page 4 Emerging Issues in Hepatitis D Hepatitis D is the most severe form of viral hepatitis, leading to early cirrhosis and decom-pensation 1. Hepatitis D or delta virus (HDV) can be acquired either by co-infection with hepatitis B virus (HBV) or by super-infection of someone already harboring chronic hepatitis B. Like HBV, hepatitis D is transmitted parenterally through exposure to infected blood or body fluids. Worldwide, about 15-20 million HBsAg positive patients are co-infected with HDV. The disease continues to be a major medical menace in the Asia Pacific region, especially Pakistan, Mongolia, and Eastern Europe 2. Hepatitis B virus surface antigen (HBsAg) helps HDV to enter hepatocytes through the same re-ceptors as of HBV and later to assemble the virion in the hepatocyte. The liver bile acids transporter sodium taurocholate co-transporting polypeptide (NTCP), which is responsible for the majority of sodium-dependent bile salts uptake by hepatocytes, also functions as a cellular receptor for viral entry of HBV and HDV through a specific interaction with the pre-S1 domain of HBV large envelope protein 3. HDV does not have replicative machinery of its own. The virus is replicated by host RNA polymerases. Host mediated post-translational changes of proteins, such as prenylation of large delta antigen, is crucial for interaction with the HBsAg in the assembly of the virion. The baseline-event-anticipation score (BEA score) has been developed based on variables associated with the development of progressive HDV related disease and liver-related clinical complications 4. The score is useful for the management of hepatitis D to decide which patients most urgently require antiviral therapy or need closer monitor-ing. The BEA score includes age, sex, and region of origin, as well as bilirubin, platelets, and international normalized ratio (INR). The BEA score is easy to apply. The score can be used to identify subjects with a low, moderate, or high risk for disease progression.

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