Interferon

The full name for the type of interferon doctors use now is pegylated-interferon alpha. You might also see it called Peg or Peg-IFN.

There are a number of things that mean you cannot take interferon. These include being pregnant, breast feeding and having decompensated cirrhosis.

Interferon works by boosting and supporting the body’s immune system to help fight the infection. It also stops the hepatitis D virus from making copies of itself. This reduces the amount of virus. Interferon also helps control hepatitis B.

During treatment your doctor will check the levels of viral RNA in your blood (viral load) to see how well interferon is working for you. Treatment usually lasts for nearly a year (48 weeks). But your doctor can look at a personalised plan if needed.

Unfortunately, interferon does not work for everyone. Many people don’t get a big enough drop in their viral load. If this happens, you may be able to take bulevirtide.

Interferon can also have a number of side effects. Common ones include:

•  Flu-like symptoms
• Muscle pains
• Headaches
• Feeling tired (fatigue)
• Weight loss
• Depression
• ‘Brain fog’
• Hair loss
• Rashes or soreness from injections

You take interferon as weekly injections that you give yourself. Flu-like symptoms tend to start 4 to 6 hours after the injection. So it can help to take paracetamol 2 to 3 hours after the injection and then every 4 to 6 hours. Check with your nurse or doctor how much to take, as you may need to take a lower dose.

It can also help to have your injection in the evening so you can sleep through the symptoms.

It’s normal to have a high temperature (over 38 degrees) when you first start taking interferon. If it doesn’t go back to normal within 48 hours tell your doctor or specialist nurse.

When you first start taking interferon it can be helpful to take a few days off work and ask someone to help with things like childcare.

Some people find that the side effects of interferon are quite severe and affect their everyday life.  Tell your doctor if side effects are a problem for you. For example they stop you doing your usual activities. If you are thinking of stopping your interferon treatment, always talk to your medical team first.

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Bulevirtide

You can have bulevirtide if:

• You have serious scarring (fibrosis) in your liver
• You do not have decompensated cirrhosis
• You either cannot take interferon or it has not worked for you

You cannot have bulevirtide if you are pregnant or breastfeeding.

Bulevirtide works by stopping the virus from getting into liver cells. This means fewer cells are infected and levels of the virus fall.

Bulevirtide is used increasingly often nowadays, as most patients respond well and have few side effects. If you are interested in trying it, speak to your doctor about whether it could be an option for you.

As with interferon, your doctor will check your viral load regularly – ideally hepatitis D RNA will become undetectable. You will also have your ALT levels measured regularly. This is a marker of liver damage (inflammation), so improved readings, or a reading within the normal range is a good result.

Bulevirtide has fewer side effects than interferon, and is usually much better tolerated. The main side effects are:

• redness, swelling or irritation where it was injected
• headaches
• itching
• raised levels of bile acids in the blood
• joint pain
• dizziness
• tiredness (fatigue)
• feeling like you have flu
• feeling sick
• allergic reaction

Tell your doctor if the side effects make it difficult for you to do your day-to-day activities or make it hard to keep taking bulevirtide. Do not just stop taking your medicine.

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Treatment for people with decompensated cirrhosis

At the moment there is no approved medicine for hepatitis D in people with decompensated cirrhosis. This is because the treatments might not be safe for someone whose liver is not working properly.

In these cases, the main treatment is a liver transplant. You will need to have an assessment to check that a transplant is the best option for you and that you will be able to recover well. The first step is a conversation with your doctor. Read more about liver transplants.

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