aidsВИЧ-инфекция и иммуносупрессииHIV Infection and Immunosuppressive Disorders2077-9828Baltic Medical Education Center10.22328/2077-9828-2026-18-2-21-33aids-1161Research ArticleЛЕКЦИЯLECTUREСовременный взгляд на гепатит D: от патогенеза до новых методов леченияCurrent perspective on hepatitis D: from pathogenesis to novel therapeuticshttps://orcid.org/0009-0001-8462-371XАрбузоваО. В.ArbuzovaO. V.

Арбузова Ольга Владимировна

Санкт-Петербург

Arbuzova Olga Vladimirovna

St. Petersburg

Ugerashka@gmail.comhttps://orcid.org/0000-0003-2270-8897ОстанковаЮ. В.OstankovaYu. V.

Останкова Юлия Владимировна - кандидат биологических наук

Санкт-Петербург

Ostankova Yulia Vladimirovna - Cand. of Sci. (Bio.)

St. Petersburg

shenna1@yandex.ruhttps://orcid.org/0000-0002-3139-3674ЩемелевА. Н.ShchemelevA. N.

Щемелев Александр Николаевич - кандидат биологических наук

Санкт-Петербург

Shchemelev Alexander Nikolaevich - Cand. of Sci. (Bio.)

St. Petersburg

tvildorm@gmail.comhttps://orcid.org/0000-0003-4571-8799ТотолянА. А.TotolianA. A.

Тотолян Арег Артемович - доктор медицинских наук, профессор, академик РАН

Санкт-Петербург

Totolyan Areg Artemovich — Dr. of Sci. (Med.), Professor, Full Member of the Russian Academy of Sciences

St. Petersburg

totolian@pasteurorg.ruСанкт-Петербургский научно-исследовательский институт эпидемиологии и микробиологии имени ПастераРоссияSaint Petersburg Pasteur InstituteRussian Federation2026130820261822133Copyright © Арбузова О.В., Останкова Ю.В., Щемелев А.Н., Тотолян А.А., 20262026Арбузова О.В., Останкова Ю.В., Щемелев А.Н., Тотолян А.А.Arbuzova O.V., Ostankova Y.V., Shchemelev A.N., Totolian A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://hiv.bmoc-spb.ru/jour/article/view/1161

Гепатит D (ГD) — тяжелое инфекционное заболевание печени, вызываемое дефектным РНК-содержащим вирусом (ВГD), репликация которого облигатно зависит от вируса гепатита B (ВГВ), предоставляющего белки оболочки. Заболевание ассоциировано с высоким риском быстрого развития цирроза и гепатоцеллюлярной карциномы. Цель настоящей лекции состоит в том, чтобы дать целостное представление о современных данных по эпидемиологии, патогенезу, диагностике и терапии гепатита D, а также обозначить ключевые нерешенные вопросы в этой области. В рамках лекции обобщены ключевые аспекты заболевания. Рассмотрены биология ВГD и его облигатная зависимость от ВГВ, определяющая уникальный патогенез с прямым цитопатическим и иммуноопосредованным повреждением. Приведены современные эпидемиологические данные, указывающие на значительное и часто скрытое глобальное бремя болезни. Описаны алгоритмы диагностики, их возможности и ограничения, связанные с вариабельностью вируса. Освещена эволюция терапии от интерферонов к новым таргетным препаратам, а также роль и ограничения вакцинопрофилактики ВГВ как основной превентивной меры. В лекции подчеркивается, что эффективный контроль над ГD требует комплексного подхода, сочетающего развитие специфической противовирусной терапии, расширение диагностического скрининга и неуклонное укрепление глобальных программ вакцинопрофилактики ВГВ. Таким образом, ключевой вызов заключается в необходимости сочетать глобальное расширение простой и эффективной профилактики с разработкой принципиально новых, более действенных методов лечения и диагностики для миллионов уже инфицированных пациентов.

Hepatitis D (HD) is a severe infectious liver disease caused by a defective RNA virus, the hepatitis D virus (HDV), whose replication is obligately dependent on the hepatitis B virus (HBV), which provides envelope proteins. The disease is associated with a high risk of rapid progression to cirrhosis and hepatocellular carcinoma. The aim of this lecture is to provide a comprehensive overview of current data on the epidemiology, pathogenesis, diagnosis, and treatment approaches for hepatitis D, as well as to highlight key unresolved questions in this field. The lecture summarizes key aspects of the disease. It examines the biology of HDV and its obligate dependence on HBV, which defines a unique pathogenesis involving direct cytopathic and immune-mediated damage. Current epidemiological data are presented, indicating a significant and often hidden global disease burden. Diagnostic algorithms, their capabilities and limitations related to viral variability, are described. The evolution of therapy from interferons to novel targeted drugs is highlighted, along with the role and limitations of HBV vaccination as the primary preventive measure. The lecture emphasizes that effective control of HD requires a comprehensive approach combining the development of specific antiviral therapy, the expansion of diagnostic screening, and the steadfast strengthening of global HBV vaccination programs. Thus, the key challenge lies in the need to combine the global expansion of simple and effective prevention with the development of fundamentally new, more effective treatment and diagnostic methods for millions of already infected patients.

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The authors declare that there are no conflicts of interest present.