Bulevirtide Treatment of Hepatitis Delta Virus Infection in a Kidney Transplant Recipient: A Case Report

OBJECTIVES: Hepatitis delta virus infection poses a significant challenge in solid-organ transplant recipients due to its aggressive nature and limited therapeutic options. Bulevirtide is a novel antiviral agent approved by the European Medicines Agency in 2020 for the treatment of hepatitis delta virus infection, but limited data are available on its use in solid-organ transplant recipients. MATERIALS AND METHODS: We present a case report of a 42-year-old male kidney transplant patient with coinfection of hepatitis B virus and hepatitis delta virus who was treated with bulevirtide over a 6-month period. RESULTS: The patient exhibited virological and bioc-hemical responses and achieved undetectable serum hepatitis delta virus RNA and normalized transaminase levels within 2 months of therapy. Bulevirtide was well tolerated, with only mild tenderness at the injection site and mild asthenia. Pharmacological evaluation indicated potential drug interactions with tacrolimus, which led to increased serum levels of tacrolimus, whereas everolimus levels remained stable. CONCLUSIONS: This case emphasizes the importance of an individualized treatment approach and highlights the potential efficacy of bulevirtide in solid-organ transplant recipients with hepatitis delta virus infection. Further research is warranted to better understand manage-ment factors in this patient population.