215.4 📌 章末速蚘

215.4.0.0.1 HDV
  • Defective ssRNA requiring HBV (HBsAg)
  • Co-infection (5-20% fulminant, 90% resolve)
  • Superinfection (70-90% chronic, accelerated cirrhosis + HCC)
  • Bulevirtide (Hepcludex) — NTCP inhibitor, 2020 EU + FDA breakthrough 2024
  • Endemic: Mediterranean, E Europe, Mongolia, Amazon
215.4.0.0.2 HEV
  • ssRNA Hepevirus, 4 main genotypes
  • Genotype 1, 2: human-only, fecal-oral, S Asia + Africa outbreaks
  • Genotype 3, 4: zoonotic (pork, wild game), Europe + Asia sporadic
  • Severe pregnancy (3rd trimester) 20-30% mortality (Genotype 1)
  • Chronic in immunocompromise (Genotype 3) → cirrhosis
  • Treatment chronic: ribavirin + reduce immunosuppression
  • Vaccine Hepai 239 (China only)
  • Extrahepatic GBS + neuralgic amyotrophy + transverse myelitis
  • Diagnosis: anti-HEV IgM + HEV RNA PCR
215.4.0.0.3 Both
  • 通報 mandatory in most countries
  • Test all HBV patients for HDV at least once
  • Test elevated LFT in immunocompromise for HEV PCR
  • WHO 2030 viral hepatitis elimination goals