# Hepatitis D Virus Pathogenesis: A Sense of Complications

## TL;DR

This paper reviews how Hepatitis D Virus causes severe liver disease and cancer, emphasizing the need for better treatments and screening.

## Contribution

The paper provides a comprehensive overview of HDV pathogenesis and its role in hepatocellular carcinoma, leading to its classification as a carcinogen.

## Key findings

- HDV contributes to liver cirrhosis and hepatocellular carcinoma through both direct and indirect mechanisms.
- HDV was classified as a group 1 carcinogenic agent in 2025 due to its role in liver cancer progression.
- Routine HDV screening and intensified HCC surveillance are urgently needed for patients with chronic hepatitis D.

## Abstract

Hepatitis D virus (HDV) is a satellite RNA virus of the hepatitis B virus (HBV) infecting an estimated 12 million people worldwide. Chronic HDV infection is causing the most severe form of chronic viral hepatitis, leading to a rapid progression of chronic inflammation to fibrosis, cirrhosis, liver decompensation and cancer. The detailed mechanisms responsible for HDV pathogenicity and its contribution to the development of hepatocellular carcinoma (HCC) are not clearly understood. This review aims to summarize the current knowledge of HDV-induced injuries, which gradually accumulate and increase the oncogenic pressure in the liver. Here, we provide a comprehensive yet concise overview of the following topics: (1) virus sensing and innate responses, (2) molecular basis of HDV pathogenesis, and (3) pathogenesis of chronic HDV infection in patients. We summarize the compelling evidence of the direct and indirect contributions of HDV to the development of HCC, which is driven by the rapid progression to liver cirrhosis. These results led to the classification of HDV as a group 1 carcinogenic agent in 2025 and emphasize the urgent need for improved antiviral and chemopreventive treatments. In addition, it highlights the necessity of routine HDV screening in patients with chronic hepatitis B and intensified HCC surveillance in patients with chronic hepatitis D.