Hepatitis D Declared Carcinogenic, WHO Calls for Urgent Global Response

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Summary:

The World Health Organization (WHO) has classified hepatitis D as carcinogenic to humans, a meaningful step in raising awareness and improving interventions for this infection which only affects individuals with hepatitis B. Hepatitis D increases the risk of liver cancer by two to six times compared to hepatitis B alone. While hepatitis C can be cured with oral medicine and hepatitis B can be managed with lifelong therapy, treatment options for hepatitis D are still evolving.Despite progress in national hepatitis action plans and policies for hepatitis B testing and vaccination, critical gaps remain in diagnosis and treatment coverage for both hepatitis B and C. Current rates are substantially below WHO’s 2025 targets. Integration of hepatitis services into primary healthcare, HIV programs, and harm reduction centers is also uneven.

The WHO is collaborating with Rotary International and the World Hepatitis Alliance for World Hepatitis Day, with the campaign “Hepatitis: Let’s break it down” aiming to address the rise in liver cancer and dismantle barriers to prevention, testing, and treatment. This partnership highlights the importance of civil society and community involvement in achieving hepatitis elimination. To meet WHO’s 2030 targets, countries need to prioritize domestic investment, integrated services, better data, affordable medicines, and ending stigma.Questions:

1. What is the new classification of hepatitis D by the WHO?
2. What is the increased risk of liver cancer associated with hepatitis D compared to hepatitis B alone?
3. What are the current treatment outcomes for hepatitis C and hepatitis B?
4. What are the key challenges and gaps in current hepatitis responses, according to the 2024 Global Hepatitis Report?
5. What are the WHO’s 2030 targets for hepatitis elimination, and what impact could achieving them have?
6. What is the theme of this year’s World Hepatitis Day campaign, and who is the WHO partnering with?

What specific mechanisms contribute to the synergistic effect between HBV and HDV in accelerating liver cancer development?

Understanding the New Carcinogenic Classification

The World Health Association (WHO) has recently declared Hepatitis D virus (HDV) as a confirmed human carcinogen. This meaningful update underscores the critical need for increased awareness, prevention, and treatment strategies worldwide. While Hepatitis B virus (HBV) has long been recognized as a risk factor for liver cancer, this new classification directly links HDV infection to the development of hepatocellular carcinoma (HCC), the most common type of liver cancer. This isn’t a new disease, but the understanding of its long-term consequences is evolving.

What is Hepatitis D and Why is it Dangerous?

Hepatitis D is a unique virus. It cannot establish an infection on its own. It requires the presence of Hepatitis B to replicate. This makes it a “dependent” virus.

Here’s a breakdown of key facts:

Co-infection: HDV always occurs in individuals already infected with HBV.

Severity: HDV often results in a more severe form of hepatitis and faster progression to cirrhosis, even in individuals with mild HBV infection.

Transmission: Similar to HBV, HDV is primarily transmitted through exposure to infective blood. This includes:

Transfusions of contaminated blood and blood products.

Contaminated injections during medical procedures.

Injection drug use.

Less commonly, sexual transmission.

Global Prevalence: An estimated 5% of people with chronic HBV are also infected with HDV, representing around 15-20 million people globally. However, prevalence varies considerably by region.

The Link Between Hepatitis D and Liver Cancer

The WHO’s declaration is based on accumulating evidence demonstrating a clear causal relationship between chronic HDV infection and the development of liver cancer. The mechanisms are complex, but involve:

Increased Inflammation: HDV exacerbates liver inflammation, accelerating liver damage.

Rapid Fibrosis: It promotes rapid fibrosis (scarring) of the liver, leading to cirrhosis.

Genetic Damage: Chronic inflammation and cell damage can lead to genetic mutations, increasing the risk of HCC.

Synergistic Effect: The combination of HBV and HDV appears to have a synergistic effect, meaning the risk of liver cancer is greater than the sum of the risks from each virus alone.

WHO’s urgent Call to Action: Key Recommendations

The WHO’s response focuses on several key areas:

1. Enhanced Surveillance: Improved global surveillance of HDV prevalence and incidence is crucial. This includes better diagnostic testing and data collection.
2. prevention of HBV: Since HDV requires HBV to exist, preventing HBV infection is the primary preventative measure. This includes:

Global infant HBV vaccination.

Safe injection practices.

Blood safety measures.

Screening of blood donations.

1. HDV-Specific Diagnostics: Increased access to HDV-specific diagnostic tests is essential for identifying and managing co-infected individuals.
2. Treatment Access: Currently,the only approved treatment for HDV is interferon-alpha,which has limited efficacy and significant side effects. Research and development of new, more effective therapies are urgently needed.
3. Public Awareness: Raising public awareness about HDV, its transmission routes, and the importance of prevention is vital.

Diagnosing Hepatitis D: What to Expect

Diagnosing Hepatitis D requires specific blood tests.Standard Hepatitis B tests do not detect HDV.

HDV Antibody: Detects past or present HDV infection.

HDV RNA: Detects active HDV infection. This is the most reliable test for confirming current infection.

Liver Function Tests (LFTs): Assess liver damage and inflammation.

Liver Biopsy: May be necessary to assess the severity of liver damage.

Protecting Yourself: Prevention Strategies

While HDV requires HBV, taking steps to prevent HBV infection is the most effective way to protect yourself.

Vaccination: Get vaccinated against Hepatitis B. This is the most important preventative measure.

Safe Sex Practices: Practice safe sex, including using condoms. while sexual transmission is less common, it is possible.

Avoid Sharing Needles: Never share needles or syringes for any reason.

Safe Medical Procedures: Ensure that any medical procedures involving injections are performed with sterile equipment.

blood Safety: If you require a blood transfusion, ensure that the blood has been properly screened for HBV and HDV.

The Future of Hepatitis D Research

Ongoing research is focused on:

New Antiviral Therapies: Developing direct-acting antivirals (DAAs) specifically targeting HDV. Several promising candidates are currently in clinical trials.

Immunotherapies: Exploring immunotherapeutic approaches to boost the immune system’s ability to clear HDV.

Understanding HDV Pathogenesis: Gaining a deeper understanding of how HDV causes liver damage.

Disclaimer: *I am Dr. Priya Des