About Hepatitis D (Delta Hepatitis, HDV)
Hepatitis D is an acute or chronic RNA virus structurally unrelated to hepatitis A, B, and C. It is an "incomplete virus" which requires the presence of hepatitis B to manifest and replicate.
Why it is Problematic
Hepatitis B is a serious liver disease that has the potential to cause liver damage, fulminant hepatitis, liver failure and death. Up to 5% of those with the hepatitis B and D co-infection will acquire fulminant hepatitis. Up to 20% of patients with chronic hepatitis B and D co-infection will get fulminant hepatitis. Mortality rates for those with fulminant hepatitis are 80%. Contracting a super infection is 10 times more likely in hepatitis D, than other forms of hepatitis. 60-70% of those with a chronic hepatitis D infection will develop cirrhosis, which occurs about 2 years after the onset of the infection. The overall mortality rate of hepatitis D is 2-20%, ten times that of hepatitis B alone.
Causes and Risk Factors
Hepatitis D can only manifest in an individual already infected with hepatitis B. Hepatitis D is commonly spread via percutaneous (passed through the skin), or mucosal contact with infected blood.
When symptoms are present they usually appear 14-180 days after infection. Common symptoms include:
- Muscle pain
- Low-grade fever
- Lack of appetite
- Joint pain
- Sore throat
- Dark urine
- Lighter than usual stool color
- Abdominal pain
- Jaundice (yellowing of the skin and whites of the eyes)
Hepatitis D can be suspected in anyone infected with the hepatitis B virus. Blood tests, and serological exams (tests that evaluate bodily fluids including blood serums), can detect the presence of antibodies indicating the virus.
Treatment and Prevention
Hepatitis D prevention is based on the prevention of hepatitis B. Hepatitis D requires hepatitis B as a surface antigen. There is no vaccine for hepatitis D, but a vaccine for hepatitis B will prevent both infections.
Carriers of the hepatitis B virus should be educated about risks factors for transmission of the hepatitis B virus such as, risky behaviors and mother to child transmission.
There is no specific treatment for hepatitis D. Immunosuppressive therapy and antiviral drugs has shown no positive clinical effect. Interferon can assist the virus into remission, but the patient will remain positive for hepatitis D RNA.
For fulminant acute and chronic hepatitis D infections, liver transplants have been proven an effective treatment.
Hepatitis D is found worldwide, although it is relatively uncommon in the U.S.- except in drug users and hemophiliacs. Men who have sex with men and healthcare workers are at high risk for hepatitis B but not for hepatitis D, though the reasons for this are unclear. Worldwide, more than 10 million people are infected with hepatitis D.