In Conversation: Dr. Ira Jacobson on Hepatitis Delta

As a child, Dr. Ira Jacobson first saw biology come alive through a microscope and discovered the spark that led him to medicine. Today, as a renowned hepatologist and a longtime leader in viral hepatitis research, he brings that same curiosity and focus to some of the field’s toughest questions.

In this Q&A, he explains why hepatitis delta demands urgent attention, how current treatment options fall short and what could move care forward. His perspective blends scientific rigor with a clear focus on the people behind the diagnosis.

What makes hepatitis delta uniquely severe compared to other viral hepatitis infections, and why does timely viral suppression matter for patient outcomes?

Dr. Ira Jacobson: Hepatitis delta virus (HDV) infection can only occur in people who have hepatitis B. Hepatitis delta is the most aggressive form of viral hepatitis because it can drive severe liver inflammation and scarring resulting in cirrhosis and liver cancer, often faster than hepatitis B or C alone. That is why early diagnosis, close follow-up, and treatment planning are so important. I believe that prompt initiation of treatment should be offered as soon as possible in patients with significant scarring. In practice, I favor treating every patient with hepatitis delta as someone at meaningful risk, even when symptoms are absent or liver damage appears mild at first.

As the hepatitis delta treatment landscape advances, where do the greatest unmet needs remain for patients?

Dr. Ira Jacobson: Today’s HDV treatment landscape remains limited. Interferon has been used historically, but its utility is constrained by significant toxicity and tolerability concerns. More recent therapies have represented important progress, including options that can be self-administered at home, reducing treatment burden and making therapy easier to integrate into daily life. Even with these advances, there is still a need for therapies that are simpler to manage over the long term. Achieving the best outcomes for the widest range of patients remains an important goal as the HDV treatment landscape continues to evolve.

Clinically, what does achieving “target not detected” (TND) signify for people with HDV, and how does it influence long-term disease progression or liver health?

Dr. Ira Jacobson: The most clinically meaningful measure of viral clearance is when a patient reaches undetectable virus, also known as "target not detected." This shows that treatment has pushed HDV RNA below the level of detection and is expected to result in improved clinical outcomes, especially if sustained.

A negative result showing HDV suppression at one point does not guarantee a permanent response or warrant cessation of treatment, which needs to be continued for an extended period over time to prevent relapse. Observations thus far suggest that early achievement of viral undetectability is not only valuable in delaying more liver damage but is also an important predictor of sustained response after treatment is eventually stopped. Durable viral suppression remains one of the best markers we have for improving liver health in patients with HDV, lowering the risk of progression to cirrhosis and, ultimately, reducing complications such as liver failure and liver cancer, which can follow from advanced liver disease.

What characteristics will define a potential new standard of care, especially regarding achieving TND, durability, safety and ease of use?

Dr. Ira Jacobson: The next standard of care should do four things well: achieve deep viral suppression reliably bringing patients to “target not detected,” hold that response over time, remain safe across a broad range of patients and fit as easily as possible into daily life. Just as important, it should give clinicians confidence to treat earlier before extensive liver damage has developed.