* This is the Professional Version. *
Hepatitis D
Patient Education
- Hepatitis
- Causes of Hepatitis
- Overview of Acute Viral Hepatitis
- Fulminant Hepatitis
- Overview of Chronic Hepatitis
- Hepatitis A, Acute
- Hepatitis B, Acute
- Hepatitis B, Chronic
- Hepatitis C, Acute
- Hepatitis C, Chronic
- Hepatitis D
- Hepatitis E
Hepatitis D is caused by a defective RNA virus (delta agent) that can replicate only in the presence of hepatitis B virus. It occurs uncommonly as a coinfection with acute hepatitis B or as a superinfection in chronic hepatitis B.
(See also Causes of Hepatitis and Overview of Acute Viral Hepatitis.)
Hepatitis D is usually transmitted by parenteral or mucosal contact with infected blood or body fluids. Infected hepatocytes contain delta particles coated with hepatitis B surface antigen (HBsAg).
Prevalence of hepatitis D virus (HDV) varies widely geographically, with endemic pockets in several countries. Parenteral drug users are at relatively high risk, but HDV, unlike hepatitis B virus (HBV) has not widely permeated the homosexual community.
Symptoms and Signs
Acute hepatitis D infection typically manifests as
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Unusually severe acute HBV infection (coinfection)
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An acute exacerbation in chronic HBV carriers (superinfection)
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A relatively aggressive course of chronic HBV infection
Diagnosis
In the initial diagnosis of acute hepatitis, viral hepatitis should be differentiated from other disorders causing jaundice (see Figure: Simplified diagnostic approach to possible acute viral hepatitis.). If acute viral hepatitis is suspected, the following tests are done to screen for hepatitis viruses A, B, and C:
If serologic tests for hepatitis B confirm infection and clinical manifestations are severe, antibody to HDV (anti-HDV) levels should be measured. Anti-HDV implies active infection. It may not be detectable until weeks after the acute illness.
Treatment
No treatments attenuate acute viral hepatitis, including hepatitis D. Alcohol should be avoided because it can increase liver damage. Restrictions on diet or activity, including commonly prescribed bed rest, have no scientific basis.
Most patients may safely return to work after jaundice resolves, even if AST or ALT levels are slightly elevated.
For cholestatic hepatitis, cholestyramine 8 g po once/day or bid can relieve itching.
Prevention
No product exists for immunoprophylaxis of hepatitis D. However, prevention of HBV infection prevents HDV infection.
Key Points
* This is the Professional Version. *
Also of Interest
Test your knowledge
Portal hypertension is elevated pressure in the portal vein. Which of the following is the most common cause of the disorder in developed countries?
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