Overview
Hepatitis D virus (HDV) is a virus that requires hepatitis B virus (HBV) for its replication – and as such it is only possible to contract HDV if you are also currently suffering from hepatitis B.
- HDV affects about 5% of those with HBV
Risk factors are similar to those for HBV and are related to broken skin or contact with infected blood and infected blood products. Factors include:
- IV drug use
- Recipients of haemodyalsis
- Indigenous populations
- Can be transmitted via close personal contact
Vaccination against hepatitis B is the only way to prevent hepatitis D infection.
There are several geographical areas of high risk including; Mongolia, Moldova, Western and Central Africa.
There are two types of clinical presentation:
- Co-existant infection – 90% of cases – this actually reduces the severity of the hep B infection! This is because infection with hepatitis D can reduce the replication rate of the hepatitis B virus. These people will usually make a full recovery from an unremarkable acute hepatitis. Co-infection tends to occur when both HBV and HDV are contracted simultaneously
- Superinfection – 10% of cases – this greatly worsens prognosis. It is due to chronic infection with both viruses. It is associated with very high levels of anti-HDV in the blood.
- Superifnection occurs when HDV is contracted in an individual already suffering from chronic HBV infection.
- Superinfection leads to cirrhosis on average 10 years sooner than in those with chronic HBV alone
- With both types of co-infection there is an increased risk of fulminant liver disease.
- There is only one identified antigen – HDV. The test for infection with hep D is anti-HDV.
Presentation
The presentation of HDV infection is similar to other forms of acute viral hepatitis. Symptoms appear 3-7 weeks after infection and may include:
- Fever
- Fatigue
- Loss of appetite
- Nausea
- Vomiting
- Dark stools
- Pale urine
- Jaundice
- <5% of cases go on to develop fulminant hepatitis
Diagnosis
- Diagnosed on blood test with the detection of anti-HDV IgG and IgM
- HDV RNA can also be detected
Management
- Interferon alpha is the recommended treatment
- Treatment is recommended for 48 weeks
- Treatment is associated with reduced likelihood of disease progression
- Has significant side effects. Contraindicated in cirrhosis, psychiatric conditions and autoimmune disease
References
- Murtagh’s General Practice. 6th Ed. (2015) John Murtagh, Jill Rosenblatt
- Oxford Handbook of General Practice. 3rd Ed. (2010) Simon, C., Everitt, H., van Drop, F.
- Beers, MH., Porter RS., Jones, TV., Kaplan JL., Berkwits, M. The Merck Manual of Diagnosis and Therapy
- WHO – Hepatitis D
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