Hepatitis D Infection

Hepatitis D Infection

Article
Digestive Health
Sexual Health
+2
Contributed byMaulik P. Purohit MD MPHMay 29, 2018

What are the other Names for this Condition? (Also known as/Synonyms)

  • Delta Hepatitis Infection
  • Hepatitis D Viral Infection
  • Infection by Delta Agent

What is Hepatitis D Infection? (Definition/Background Information)

  • Hepatitis D Infection is a condition that is caused by the hepatitis D virus
  • However, in order for Hepatitis D Infection to occur, it must occur in conjunction with hepatitis B virus. As a result, either a co-infection or super-infection takes place
  • When co-infection occurs, an individual is simultaneously exposed to both hepatitis D and B viruses, at the same time. As a result, it can result in an acute infection
  • A super-infection occurs, when an individual who is already and chronically infected by hepatitis B virus, is exposed to the hepatitis D virus
  • A past infection with hepatitis B, use of intravenous drugs or needles, and multiple sex partners can increase one’s risk of developing Hepatitis D Infection
  • The signs and symptoms of Hepatitis D Infection can include jaundice, fatigue, loss of appetite, dark urine, and joint pain. Also, the infection typically causes the symptoms of hepatitis B infection to worsen
  • The treatment of Hepatitis D Infection depends on the severity of the disease, but commonly includes the use of medications (alpha-interferons and nucleoside inhibitors). The prognosis of the condition depends on what form of infection is present
  • Individuals with acute Hepatitis D Infection are usually able to improve within 2-3 weeks of being infected. In Individuals with super-infection, the infection is likely to turn chronic in 80% of the cases
  • Preventative measures to reduce the likelihood of developing Hepatitis D Infection can include receiving the hepatitis B vaccine, avoiding exposure to contaminated blood and blood products, avoiding sharing of needles, and practicing safe sex methods

Who gets Hepatitis D Infection? (Age and Sex Distribution)

  • Hepatitis D Infection affects about 15 million people worldwide. The infection has the highest incidence rate in parts of Russia, Romania, Southern Italy, and other Mediterranean countries
  • In Mediterranean countries, Hepatitis D Infection is endemic to hepatitis B carriers and the virus is transmitted by close personal contact
  • In Western Europe and North America, however, the infection is confined to individuals who have been exposed to infected blood or blood products
  • The condition is observed across all age groups and both male and female genders are affected

What are the Risk Factors for Hepatitis D Infection? (Predisposing Factors)

The risk factors of Hepatitis D Infection include:

  • Prior infection with hepatitis B virus
  • Use of intravenous (IV) or injection drugs
  • Getting infected with hepatitis D virus while being pregnant; the expectant mother can pass on the virus to the baby
  • Individuals who have sexual intercourse with multiple sex partners
  • Receiving blood transfusions that are contaminated

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Hepatitis D Infection? (Etiology)

  • Hepatitis D Infections is caused by the hepatitis D virus.
  • However, the hepatitis D virus alone cannot cause an infection. It can only occur, if an individual already carries the hepatitis B virus
  • The Hepatitis D virus requires the presence of hepatitis B virus in order to infect and replicate within the hepatocytes (liver cells)
  • The infection spreads either percutaneously (such as through needle puncture) or through contact with infected blood or blood products

Hepatitis D Infection can occur as two types:

  • Co-infection: When there is a simultaneous exposure to hepatitis D and hepatitis B infections, which results in an acute infection
  • Super-infection: When there already is a chronic infection by hepatitis B virus, which is followed by an exposure to the hepatitis D virus

What are the Signs and Symptoms of Hepatitis D Infection?

Usually, the signs and symptoms of Hepatitis D Infection arise within 3-7 weeks after being infected by the virus. The common signs and symptoms of Hepatitis D Infection include:

  • Jaundice - yellowing of the skin and/or the eyes
  • Gastrointestinal abnormalities that may include nausea, vomiting, and abdominal pain
  • Fatigue and tiredness
  • Appetite loss
  • Dark-colored urine
  • Joint pain

Hepatitis D Infection can also worsen the symptoms that are caused by hepatitis B infection, making the condition more severe.

How is Hepatitis D Infection Diagnosed?

Hepatitis D Infection is diagnosed using the following tools:

  • Complete evaluation of the individual’s medical history and a thorough physical examination. An evaluation of medical history will determine, if there is the presence of predisposing factors such as intravenous drug use, previous infection to hepatitis B virus, or unsafe sexual practices
  • The anti-delta agent antibody test can be used to diagnose Hepatitis D Infection. If the individual shows a positive result to the anti-delta antibody in blood, it is likely that they have been infected
  • Blood tests that measure liver enzymes can also be used to diagnose the infection. Abnormal levels of liver enzymes indicate that liver damage has occurred due to Hepatitis D Infection
  • A liver biopsy can help determine the extent of damage (liver fibrosis) by the infection. In a liver biopsy, the physician removes a sample of the liver tissue using a biopsy needle. The tissue is sent to the laboratory for a histopathological examination. The pathologist examines the biopsy under a microscope and performs special studies on the tissues (if required)

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions in order to arrive at a definitive diagnosis.

What are the possible Complications of Hepatitis D Infection?

Complications associated with Hepatitis D Infection depend on the severity of the disease. These include:

  • Chronic active hepatitis, which is characterized by the occurrence of hepatitis for more than 6 months with severe liver damage
  • It is also possible that fulminant hepatitis develops due to the infection. This is characterized by acute liver failure and encephalopathy (brain damage due to viral infection) within 8 weeks of contracting the virus

How is Hepatitis D Infection Treated?

  • The treatment options for Hepatitis D Infection depend upon the severity of the disease. These measures are used to treat symptoms of the infection rather than cure the disease itself. Most treatment options also take several years to complete.
  • Medications (alpha-interferons) have helped bring many individuals into a complete remission. However, despite using these medications, many patients remain positive for hepatitis D virus RNA
  • Nucleoside inhibitors can also be used to treat Hepatitis D Infection and may assist in reducing the levels of hepatitis B and D virus in blood
  • Liver transplantation has been effective in treating complications, including chronic active hepatitis (an infection whose activity continues for over 6 months) and fulminant hepatitis (condition where there is extensive liver damage in a short time span)
  • Regardless of what treatment is received, follow-up care and regular screenings are important to ensure that Hepatitis D Infection does not progress and cause further complications.

How can Hepatitis D Infection be Prevented?

Hepatitis D Infection may be prevented by certain measures that include:

  • Receiving hepatitis B vaccine: The hepatitis D virus cannot be contracted unless the individual is already infected with hepatitis B virus
  • Avoiding exposure to contaminated blood and blood products
  • Avoid sharing needles and using intravenous drugs
  • Use of proper methods for safe sex, which include the use of condoms or abstinence
  • It may not be always possible to follow these preventative measures. Hence, it is important to attend regular medical and dental screenings so that Hepatitis D Infection may be detected early and properly treated.

What is the Prognosis of Hepatitis D Infection? (Outcomes/Resolutions)

  • The prognosis of Hepatitis D Infection depends on what form of the infection is present
  • Generally, individuals with acute infections begin to improve within 2 to 3 weeks of being infected with treatment. The liver enzyme levels return to normal within 16 weeks
  • In individuals with super-infections, the infection is likely to turn chronic in 80% of the cases. This can lead to liver damage, cirrhosis, and even be fatal
  • The overall mortality rate due to Hepatitis D Infection is estimated to be between 2% and 20%

Additional and Relevant Useful Information for Hepatitis D Infection:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/diseases-conditions/infection-center/

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Maulik P. Purohit MD MPH picture
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Maulik P. Purohit MD MPH

Assistant Medical Director, Medical Editorial Board, DoveMed Team

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