Hepatitis delta virus (HDV) infection requires the presence of hepatitis B virus (HBV), and chronic HBV–HDV coinfection is considered the most severe form of viral hepatitis. When compared with HBV mono-infection, HBV–HDV coinfection is associated with higher rates of liver cirrhosis and hepatocellular carcinoma (HCC). In this review, we aim to elucidate the complex relationship between HDV infection and the development of HCC. The exact mechanisms underlying the carcinogenic potential of HDV remain to be fully elucidated. Evidence suggests that HDV has both indirect and direct oncogenic effects. Indirect effects promote accelerated progression to liver cirrhosis, which results in a different tumor microenvironment. Direct oncogenic effects are suggested by a distinct molecular signature. The recent epidemiological data regarding HBV–HDV coinfection should make us reconsider the HCC screening strategy, with special focus in younger non-cirrhotic patients. Finally, treating HCC in patients with chronic HDV poses unique challenges due to the complex interplay between HBV and HDV and the severity of liver disease. An in-depth understanding of the epidemiology and pathophysiology of HDV infection and carcinogenesis is essential to improve disease management in this high-risk population.
丁型肝炎病毒（HDV）感染需以乙型肝炎病毒（HBV）的存在为前提，慢性HBV-HDV共感染被认为是病毒性肝炎中最严重的形式。与单纯HBV感染相比，HBV-HDV共感染与更高的肝硬化和肝细胞癌（HCC）发生率相关。本文旨在系统阐述HDV感染与HCC发生之间的复杂关联。目前HDV致癌潜力的确切机制尚未完全阐明，现有证据表明HDV同时具有间接与直接致癌效应：间接效应通过加速肝硬化进程，形成独特的肿瘤微环境；直接致癌效应则体现为特征性分子标志。近期HBV-HDV共感染的流行病学数据提示，需重新审视HCC筛查策略，尤其应关注年轻非肝硬化患者群体。此外，由于HBV与HDV的复杂相互作用及肝病严重程度，慢性HDV感染患者的HCC治疗面临特殊挑战。深入理解HDV感染的流行病学特征及其致癌病理生理机制，对改善这一高危人群的疾病管理至关重要。
The Changing Face of Hepatitis Delta Virus Associated Hepatocellular Carcinoma
肿瘤(癌症)患者之家