
Theme Issue: Advances and Challenges in Eliminating Hepatitis D
Executive Chief Editors:
JIA Jidong(Beijing Friendship Hospital,Capital Medical University)
NIU Junqi(The First Hospital of Jilin University)
Hepatitis D virus (HDV) infection, the most severe form of viral hepatitis, remains underrecognized in the Asia due to inconsistent screening and limited surveillance. This systematic review (1970—2025) stratified HDV prevalence by population subgroups: community, hospital-based, and high-risk.Community studies showed high prevalence in Pakistan, Kazakhstan, and Kyrgyzstan; hospital cohorts revealed hyperendemicity in Mongolia and Uzbekistan; high-risk populations showed concentrated transmission in [Hong Kong, China], [Taiwan, China], Vietnam, and Sultanate of Oman. Many countries and regions lacked subgroup-specific data.The uneven, population-dependent burden underscores HDV as a major driver of advanced liver disease in Central and South Asia. Routine HDV screening and RNA-based diagnostics are essential to define burden and advance WHO 2030 elimination targets.
Hepatitis D is an inflammatory liver disease caused by hepatitis D virus (HDV) infection, and co-infection of HDV and hepatitis B virus dramatically accelerates the progression of liver disease and significantly increases the risk of liver cirrhosis and hepatocellular carcinoma. However, due to insufficient awareness and concern about hepatitis D among the public, clinicians, and public health workers, the screening rate of hepatitis D remains at a relatively low level around the world. The true disease burden of hepatitis D has been seriously underestimated, and it has become one of the major challenges in the global campaign of hepatitis elimination. This article systematically reviews the current epidemiological situation of hepatitis D, prevention and control strategies, and related issues and challenges and analyzes the future strategies and measures for prevention and control, in order to provide a reference for promoting the achievement of the goal to eliminate viral hepatitis as a public health threat.
Hepatitis D is a severe infectious disease caused by hepatitis D virus (HDV), and its clinical manifestation and outcome vary depending on the mode of infection (co-infection and super-infection). This article systematically elaborates on the etiological markers for HDV, screening strategies for HDV infection, clinical diagnosis, and principles for treatment and management. In addition, it also discusses the challenges in etiological detection of HDV infection from the perspectives of the unique structure of the virus, genotypes, and detection techniques and reviews the new techniques in this field, in order to provide a reference for the clinical diagnosis and treatment of patients with HDV and offer new ideas for the standardization and domestication of etiological detection techniques.
Hepatitis D virus (HDV), as a defective virus, relies on the envelope protein of hepatitis B virus (HBV) to complete replication and transmission. Chronic hepatitis B (CHB) patients comorbid with HDV infection may experience significant acceleration of liver disease progression and a significantly higher risk of serious complications such as liver cirrhosis and hepatocellular carcinoma (HCC) compared with the patients with CHB alone, which poses a serious threat to the life and health of patients. At present, the coverage rate of HDV screening needs to be improved, and some patients with HBV/HDV co-infection have not been found in time. Therefore, strengthening the understanding of HDV among clinicians, expanding the scope of HDV screening, identifying patients with infection in a timely manner, and performing standardized antiviral therapy and long-term follow-up management are of great significance for improving the prognosis of patients, reducing disease burden, improving the quality of life of patients, and achieving the global goal of “eliminating viral hepatitis as a public health threat by 2030”.
Co-infection of hepatitis D virus (HDV) and hepatitis B virus (HBV) is the most severe form of viral hepatitis and is associated with accelerated progression of liver disease and a significant increase in the risk of liver cirrhosis and hepatocellular carcinoma. Nucleo(s)tide analogues for HBV treatment are ineffective against HDV infection, necessitating the urgent need for developing specific and effective antiviral therapies for HDV. In recent years, significant advances have been made in the research and development of specific antiviral drugs against HDV, including entry inhibitors targeting viral entry (Bulevirtide) and monoclonal antibody drugs (Libevitug), which bring ground-breaking advances in the treatment of HDV infection. This article briefly reviews the latest research advances in therapeutic drugs for HDV, introduces the mechanism of action and clinical research data of new drugs recently approved for the treatment of HDV, and discusses the challenges that need to be solved in the field of HDV treatment, in order to provide a reference for understanding the current status of hepatitis D treatment.
Acute-on-chronic liver failure (ACLF) is a syndrome with high mortality triggered by acute predisposing factors in patients with underlying chronic liver diseases. Clinical studies have shown that ACLF can be reversed to a certain degree, and early intervention can improve patient prognosis, whereas delayed diagnosis and treatment can lead to a significant increase in mortality. In recent years, scholars in this field have proposed the concept of “pre-acute-on-chronic liver failure (Pre-ACLF)”, which aims to improve clinical outcomes through early identification and intervention. This article systematically reviews the origin of the Pre-ACLF concept and its latest definitions in China and globally, summarizes the latest research advances in Pre-ACLF in terms of traditional clinical-laboratory parameters, high-throughput omics, and molecular biological mechanisms, and proposes the important clinical need for further unifying the definition of Pre-ACLF.
Recently, the American College of Gastroenterology (ACG) released the clinical guidelines on perioperative risk assessment and management of patients with cirrhosis, proposing a comprehensive approach for perioperative risk assessment and management in these patients. The guidelines mainly focus on the severity of liver diseases, extrahepatic comorbidities, and surgery-specific factors, with an emphasis on individualized risk stratification using validated risk assessment tools (such as the VOCAL-Penn score) for patients with cirrhosis. This article gives an excerpt of the key statements in the guidelines.
In January 2026, the European Reference Network on Hepatological Diseases released a position statement on polycystic liver disease (PLD). Compared with existing diagnosis and treatment recommendations, this statement provides the latest practical guidance on somatostatin analogues as the sole available pharmacological intervention for severe PLD, including clear criteria for eligibility, the criteria for initiation and discontinuation of treatment, and the gaps requiring further research. This statement also defines the criteria for patient selection, treatment goals, and monitoring strategies, and these updates fully reflect the latest clinical evidence and practical needs in the management of PLD. This article gives an excerpt of the key practical recommendations from the statement.
Over the past decade, with the continuous development of direct cholangioscopy and pancreatoscopy, they have been widely used in the diagnosis and treatment of various pancreaticobiliary diseases. In October 2025, United European Gastroenterology released the consensus recommendations for direct cholangioscopy and pancreatoscopy, including general recommendations for direct cholangioscopy and pancreatoscopy and specific recommendations for biliopancreatic duct stones, biliary strictures, and other indications, with an aim to provide standard guidance for the clinical diagnosis and treatment of pancreaticobiliary diseases. This article gives an excerpt of the key recommendations in the consensus.
As a coagulase-negative staphylococcus, Staphylococcus lugdunensis has stronger virulence and pathogenicity than other Staphylococcus bacteria and is comparable to Staphylococcus aureus. In recent years, there has been a gradual increase in the number of related case reports, A patient with hepatitis B cirrhosis and Staphylococcus lugdunensis bloodstream infection was admitted to our department and was followed up for more than 2 years, and the patient was analyzed in terms of clinical features, pathogenicity, invasion, and the application of related antibiotics.
Pegylated interferon α-2b (PEG-IFN-α-2b) is currently a first-line drug for the treatment of chronic hepatitis B virus infection and is widely used in clinical practice. This drug has multiple effects of inhibiting viral replication, regulating immunity, and improving liver function, and some patients can achieve clinical cure. However, it often causes various adverse reactions during treatment, which are important factors for compromising treatment compliance and efficacy. This article systematically reviews the adverse reactions and their mechanisms during PEG-IFN-α-2b therapy for chronic hepatitis B, including influenza-like symptoms, peripheral blood cytopenia, thyroid dysfunction, and neuropsychiatric symptoms, and it also summarizes the monitoring and management strategies for these adverse reactions, in order to provide evidence-based guidance for clinical decision-making and emphasize the importance of individualized treatment.
Metabolic associated fatty liver disease (MAFLD) is a common chronic liver disease worldwide, and timely and precise intervention can delay disease progression and significantly reduce the risk of serious complications such as liver fibrosis, liver cirrhosis, and liver cancer. Although traditional liver biopsy combined with metabolic markers is the gold standard, it may cause complications such as pain and bleeding as an invasive examination, which has promoted scientific research to shift its focus to the construction of noninvasive assessment systems. In recent years, noninvasive diagnostic technologies based on multi-dimensional detection strategies have been continuously updated, including serological models, imaging techniques, and clinical algorithms. This article systematically reviews the screening methods for MAFLD during the fibrotic stages F1—F3, especially deep learning models based on artificial intelligence, in order to provide ideas for the early screening of MAFLD, as well as a scientific reference for optimizing disease management strategies.
Metabolic dysfunction-associated fatty liver disease (MAFLD), as one of the most common chronic liver diseases in the world, poses a severe challenge to precision diagnosis and treatment due to its complex pathogenesis and highly heterogeneous disease progression. Existing clinical classification systems cannot meet the needs for comprehensively analyzing the complexity of the disease and the heterogeneity of its adverse outcomes. In recent years, data-driven prognostic risk classification methods have gradually emerged, optimizing the ability for predicting adverse outcomes and enhancing the accuracy of identifying different endpoint outcomes. However, such paradigm of “classify first, associate outcomes later” suffers from a “black-box” nature, and there are various indicators for classification, leading to limited stability and generalizability in clinical application. Future research needs to integrate or establish large-scale population cohorts, develop outcome-oriented prognostic risk classification models, incorporate dynamic data, refine classification algorithms, and validate their generalizability across multiple populations, thereby providing reliable support for the precision diagnosis and treatment of MAFLD.
Autoimmune liver diseases (AILD) are a group of chronic liver diseases caused by abnormal activation of the immune system, mainly including autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis, IgG4-related sclerosing cholangitis, and overlap syndrome. Clinical studies have shown that patients with AILD are often comorbid with thyroid diseases, especially autoimmune thyroid diseases (AITD), such as Graves’ disease and Hashimoto’s thyroiditis. This article systematically reviews the epidemiological association, potential shared pathogenesis, and overlapping features between AILD and thyroid diseases. A deeper understanding of the immunological links between AILD and AITD may provide a theoretical basis for precision medicine and future research.
Autoimmune hepatitis (AIH) is an immune-mediated chronic liver inflammatory disease with unknown pathogenesis, and intestinal barrier dysfunction is considered an important factor. Meanwhile, there are sex and age differences in the incidence rate of AIH, suggesting that hormone may be involved in regulation. On this basis, this article focuses on the association between estrogen, intestinal barrier, and immune homeostasis, systematically reviews the evidence that estrogen deficiency disrupts intestinal barrier homeostasis, and further summarizes the potential mechanism of estrogen in regulating the development and progression of AIH via intestinal barrier.
Liver fibrosis is caused by various factors such as viral infection, alcohol intake, and metabolism-related damage, leading to the replacement of normal tissue by fibrous scars. As a regulatory factor for cell proliferation, insulin-like growth factor 1 (IGF-1) participates in the regulation of cell cycle, the promotion of cell proliferation and differentiation, and the inhibition of cell apoptosis by binding to its receptor insulin-like growth factor-1 receptor (IGF-1R). Studies have shown that the IGF-1/IGF-1R signaling pathway can regulate the process of liver fibrosis by affecting the senescence and apoptosis of hepatocytes, the activation and proliferation of hepatic stellate cells, and the dysfunction of endothelial cells. In addition, the IGF-1/IGF-1R signaling system can also regulate multiple mechanisms such as DNA damage repair, cell proliferation, lipid metabolism, cell senescence, and oxidative stress, thereby providing new strategies and potential targets for the prevention and treatment of liver fibrosis. This article summarizes the mechanism of action of IGF-1/IGF-1R and its signal transduction system in mediating liver fibrosis by regulating DNA damage repair in different cells, in order to provide a theoretical basis for the treatment of liver fibrosis.
Gastric variceal rupture and bleeding and hepatic encephalopathy are common and life-threatening complications in decompensated cirrhosis. As a minimally invasive interventional technique, balloon-occluded retrograde transvenous obliteration (BRTO) has made significant progress in the clinical management of gastric varices and hepatic encephalopathy in recent years. This article systematically reviews the technical principles, indications (e.g., isolated gastric varices and refractory hepatic encephalopathy), clinical efficacy (an acute hemostasis rate of 85% — 95%, a 1-year rebleeding rate of <15%, and an improvement rate of 60% — 80% for hepatic encephalopathy), and safety (including complications such as renal impairment and elevated portal vein pressure) of BRTO. Meanwhile, this article discusses the advantages and disadvantages of BRTO and conventional treatment modalities (e.g., transjugular intrahepatic portosystemic shunt and endoscopic treatment) and reviews the latest technological improvements in recent years, such as coil-assisted retrograde transvenous obliteration and plug-assisted retrograde transvenous obliteration. Future research should focus on the precision of patient selection (e.g., stratification based on hemodynamic parameters), the optimization of embolic materials (e.g., application of new biodegradable embolic agents), and the development of individualized treatment regimens, so as to improve efficacy and reduce the risk of complications.
Hepatocellular carcinoma (HCC) is a malignant tumor with relatively high incidence and mortality rates worldwide, and its therapeutic resistance and recurrence mechanism are closely associated with liver cancer stem cells (LCSC). This article systematically introduces the biological characteristics of LCSC and their key role in the progression of HCC, reviews the functional characteristics of the specific surface markers (such as EpCAM and CD133) and related signaling pathways (such as Wnt/β-catenin, TGF-β, and STAT3), elaborates on the interaction between LCSC and tumor microenvironment, and summarizes the latest clinical treatment strategies targeting LCSC and the countermeasure for existing resistance mechanisms. The article points out that LCSC promote tumor development and progression through metabolic reprogramming and immune microenvironment remodeling, and it is proposed to establish a standardized detection system for LCSC specific markers and promote a triple synergistic therapeutic paradigm combining targeted therapy, immune regulation, and traditional chemotherapy, in order to provide new ideas for the clinical intervention of HCC.
Compared with traditional therapies for chronic liver disease (CLD), Bifidobacterium has the characteristics of multi-target intervention, high biosafety, and good host compatibility and provides new strategies for intervention of CLD progression in terms of microecological regulation. Various studies have shown that Bifidobacterium regulates liver homeostasis and exerts a therapeutic effect on CLD by regulating intestinal flora, maintaining antioxidation, promoting energy consumption, alleviating inflammation, improving glycolipid metabolism, and exerting an antitumor effect. This article systematically reviews the studies on Bifidobacterium in the treatment of CLD in China and globally, explores their different mechanisms, and elaborates on the interaction between related signaling pathways (such as the nuclear factor erythroid 2-related factor 2 signaling pathway and the adenosine monophosphate-activated protein kinase signaling pathway) and the liver, in order to provide a basis for probiotic intervention in liver pathology, as well as new ideas for the comprehensive treatment of CLD.
Liver injury has become an increasingly serious global health problem, and existing chemical drugs face the limitations in efficacy and adverse reactions, resulting in the urgent need to develop safe and effective drugs. Recent studies have highlighted the potential of flavonoids from natural medicinal plants in the prevention and treatment of liver injury. As a typical natural flavonoid, luteolin shows a good protective effect against liver injury due to various etiologies, but there is still a lack of systematic elaboration on its mechanism of action. This article summarizes related research advances in China and globally and reviews the mechanism of action of luteolin in inhibiting oxidative stress, exerting an anti-inflammatory effect, regulating cell death, alleviating hepatic fibrosis, modulating lipid metabolism disorders, and regulating the gut-liver axis, as well as the application prospect of luteolin in the treatment of liver injury, in order to provide a scientific reference for further research on this compound.
Acute cholangitis (AC) is a common acute abdominal disease in clinical practice, and the early accurate diagnosis of AC is of great importance for improving prognosis; however, traditional diagnostic methods are limited by insufficient sensitivity and specificity. This article systematically reviews the value of traditional serum markers (such as neutrophil-to-lymphocyte ratio, procalcitonin, and C-reactive protein) and their combination in the early diagnosis of AC, with a focus on the research advances and potential application value of novel biomarkers for infection and inflammation, including presepsin, soluble triggering receptor expressed on myeloid cells-1, lipocalin 2, high-mobility group protein B1, and intestinal fatty acid-binding protein 1. At present, the combination of multiple biomarkers and dynamic monitoring of novel markers are key strategies for enhancing the early diagnosis and risk stratification of AC. Future research should focus on the integration of novel and traditional serum markers and the construction of comprehensive predictive models, in order to promote the establishment of a standardized system for the early diagnosis of AC.
Chronic pancreatitis (CP) is a common disease in clinical practice characterized by progressive inflammatory fibrosis of the pancreas. Gut microbiota, known as the “second genome” of humans, bidirectionally modulates the progression of fibrosis in CP via the gut-pancreas axis. This article systematically elaborates on the characteristics of gut microbiota during the progression of CP and its molecular mechanism in mediating pancreatic fibrosis through bacterial translocation, metabolites, immune regulatory networks, and microbe-pancreatic stellate cell interactions, with a focus on the pivotal role of short-chain fatty acids and inflammatory cytokine networks in pancreatic stellate cell activation and extracellular matrix deposition. In addition, this article explores the potential value of gut microbiota-targeted interventions in the prevention and treatment of CP fibrosis, such as probiotics, prebiotics, and fecal microbiota transplantation, and discusses the translational potential of using multi-omics technologies to identify diagnostic biomarkers and novel therapeutic targets for CP, in order to provide new ideas for the precise diagnosis and treatment of CP.
Pancreatic cancer (PC) has a high degree of malignancy and a 5-year survival rate of <10%, with the core molecular mechanisms of Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations (90%), inactivation of tumor protein p53/cyclin-dependent kinase inhibitor 2A/SMAD family member 4, and epigenetic dysregulation (including DNA methylation and non-coding RNA alterations), which promotes the progression of PC. In recent years, breakthroughs have been made in targeted therapy, including the clinical application of KRASG12C inhibitors (sotorasib, adagrasib) and KRASG12D inhibitors, and the strategies targeting epidermal growth factor receptor, DNA repair (PARP inhibitors), and immune microenvironment (combined therapies targeting PD-1 and PD-L1) have significantly improved the treatment outcome of PC. Nevertheless, drug resistance and tumor heterogeneity remain huge challenges. Precision medicine and combined therapies should be adopted in the future to improve the prognosis of patients.
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- 1Current situation in the research of Gilbert’s syndrome
- 2Review of acute pancreatitis scoring systems
- 3Clinical value of 13C-methacetin breath test for assessing liver function in patients with cirrhosis
- 4Studies on relevant gactors of Child-Pugh grading in hepatic cirrhosis
- 5Meta-analysis of 111 patients with nonalcoholic steatohepatitis-associated hepatocellular carcinoma
- 6Research state and prospect of hyponatremia in cirrhosis
- 7Relationship between Epstein-Barr virus infection and hepatic lesions in children
- 8Congenital bile acid synthesis defect and cholestatic liver disease
- 9Interventional treatment for Budd-Chiari syndrome:reports of 883 cases
- 10
- 1The guideline of prevention and treatment for chronic hepatitis B: a 2015 update
- 2Chinese guidelines for the management of acute pancreatitis ( Shenyang , 2019 )
- 3The guideline of prevention and treatment for chronic hepatitis B(2010 version)
- 4Current situation in the research of Gilbert’s syndrome
- 5Comprehensive guidelines for the diagnosis and treatment of pancreatic cancer (2018 version)
- 6Consensus on the diagnosis and management of primary biliary cirrhosis (cholangitis)(2015)
- 7Diagnosis, management, and treatment of hepatocellular carcinoma (V2017)
- 8
- 9Consensus on the diagnosis and management of autoimmune hepatitis(2015)
- 10Guidelines for the prevention and treatment of chronic hepatitis B (version 2019)
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