Hepatitis D
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The hepatitis D virus
The hepatitis D virus

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.


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


  • Diagnosed on blood test with the detection of anti-HDV IgG and IgM
  • HDV RNA can also be detected


  • 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


  • 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

Read more about our sources

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University, and is studying for a Masters of Sports Medicine at the University of Queensland. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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