HBV Dane particles HBs Ag HBc Ag partially

HBV ιικά σωμάτια - Dane particles Αντιγόνο επιφάνειας HBs. Ag Αντιγόνο πυρηνοκαψιδίου HBc. Ag partially double-stranded, circular but not covalently closed ‘relaxed circular’ (RC) DNA in which the 5’ end of the (-)-strand is covalently linked to the viral P protein

NTCP (sodium taurocholate co-transporting polypeptide) Υποδοχέας Εισόδου HBV-HDV στο ηπατοκύτταρο Yan H, Zhong G, Xu G, He W, Jing Z et. al (2012) Elife 1: e 00049 Journal of Hepatology 2013 58, 1246 -1248 DOI: (10. 1016/j. jhep. 2013. 01. 036)

Yuri Churin, Martin Roderfeld, Elke Roeb , HBSN 2015

ccc. DNA

Barbara Rehermann, Nature Medicine 19, 859– 868 (2013)

G 1896 A = stop codon, TAG Core gene ATG 1814 Precore region ATG 1901 Core region HBe. Ag HBc. Ag Virion Serum

Ανενεργός HBs. Ag φορία § HBs. Ag+ > 6 μήνες § HBe. Ag-, anti-HBe+ § HBV DNA < 2000 IU/m. L § Κ. Φ. ALT/AST § Για ανά τρίμηνο το πρώτο έτος § Ανά έτος Lok AS, Mc. Mahon BJ. Hepatology. 2009; 50: 661 -662. Chronic Hepatitis B: Update 2009 www. aasld. org

Θεραπεία Peginterferon alfa-2 a Entecavir Lamivudine 1990 Interferon alfa-2 b 1998 2002 Adefovir 2005 Tenofovir 2006 Telbivudine 2008

Hepatitis D (Delta) Virus d antigen HBs. Ag RNA

Geographic Distribution of HDV Infection Taiwan Pacific Islands HDV Prevalence High Intermediate Low Very Low No Data

HBV – HDV Coinfection Typical Serological Course Symptoms ALT Elevated Titer Anti-HBs Ig. M anti-HDV RNA HBs. Ag Time after Exposure Total anti-HDV

HBV – HDV Super-infection Typical Serological Course Jaundice Symptoms Titer Total anti-HDV ALT HDV RNA HBs. Ag Ig. M anti-HDV Time after Exposure

Alessia Ciancio & Mario Rizzetto Nature Reviews Gastroenterology & Hepatology (2014)

Hepatitis D - Πρόληψη • HBV-HDV Coinfection – Pre or postexposure prophylaxis to prevent HBV infection (HBIG and/or Hepatitis B vaccine) ΕΜΒΟΛΙΟ HBV • HBV-HDV Superinfection – Education to reduce risk behaviors among persons with chronic HBV infection – ΕΝΗΜΕΡΩΣΗ – ΤΡΟΠΟΠΟΙΗΣΗ ΣΥΜΠΕΡΙΦΟΡΑΣ