The Role of PegIFN, Bulevirtide, Tenofovir Alafenamide, and Eltrombopag in the Management of Chronic HBV/HDV Co-Infection with Cirrhosis: An Ongoing Clinical Case
<p id="p1">Hepatitis D virus (HDV) is the most severe form of chronic viral hepatitis, accelerating progression to cirrhosis, hepatic decompensation, and hepatocellular carcinoma. Pegylated interferon alfa-2a (PegIFNα) has long been the only option, whereas bulevirtide (BLV) is now approved fo...
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| Formato: | Capítulo de libro |
| Lenguaje: | inglés |
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IntechOpen
2025
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| Acceso en línea: | https://www.intechopen.com/chapters/89835 |
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| Sumario: | <p id="p1">Hepatitis D virus (HDV) is the most severe form of chronic viral hepatitis, accelerating progression to cirrhosis, hepatic decompensation, and hepatocellular carcinoma. Pegylated interferon alfa-2a (PegIFNα) has long been the only option, whereas bulevirtide (BLV) is now approved for chronic HDV. Because BLV alone has limited impact on HBsAg clearance, combining BLV with PegIFNα is of interest, especially in compensated cirrhosis. We report a 36-year-old female with HBV/HDV co-infection who progressed from F1 to F4 fibrosis over 14 years without antiviral therapy. Despite HBeAg clearance in 2016, HBeAg seroreversion occurred in 2022 with low-level HBV DNA. Combination therapy with PegIFNα-2a (180 mcg/week) plus BLV (2 mg/day) began in January 2023. By Week 12, severe PegIFN-induced thrombocytopenia developed (platelets 150,000→32,000/mm³). Eltrombopag 25 mg every other day was introduced to maintain PegIFN dose while mitigating thrombotic risk; platelets stabilized >50,000/mm³. HDV RNA and HBV DNA became undetectable by weeks 37 and 55, respectively. PegIFN was stopped at Week 60, and therapy continued with BLV plus tenofovir alafenamide (TAF). Viral negativity persisted through Week 107; HBsAg decreased but remained detectable; HBeAg seroconversion has not yet occurred. This case illustrates: (i) the rationale for PegIFNα+BLV when finite therapy and HBsAg impact are desired; (ii) successful prevention of PegIFN dose reduction using a reduced-frequency eltrombopag regimen to manage thrombocytopenia; and (iii) the need for continued monitoring to determine durability of response and the timing of nucleos(t)ide analog initiation in the context of HBeAg seroreversion.</p> |
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| ISBN: | 978-1-80632-102-5 |
| DOI: | 10.5772/intechopen.115659 |