Hepatitis D

Introduction

Hepatitis D is a liver infection caused by the Hepatitis D virus (also called hepatitis delta virus or HDV) that results in inflammation of your liver. Hepatitis D virus is unique because it does not cause disease on its own. It can only affect people who have been infected by the hepatitis B virus. This virus can cause acute or chronic liver infection, either of which can cause severe damage to your liver. Chronic hepatitis can progress to further complications, including cirrhosis, liver cancer, or liver failure. People can get both hepatitis B and hepatitis D at the same time, or they can contract hepatitis D after contracting hepatitis B. There is no vaccination for hepatitis D. In contrast, hepatitis B vaccination protects against future hepatitis D infection.

 

Types

Hepatitis D has two types: Acute and chronic hepatitis.

Acute hepatitis D develops in the initial period once you get infected with the Hep D virus. It can cause more severe symptoms. This infection lasts for a duration of fewer than six months. Most adults recover well from acute hepatitis on their own within a few months.

Chronic hepatitis D develops if hepatitis persists for more than six months. An important cause of this condition is a weakened immune system that is unable to fight off the virus. Chronic hepatitis can lead to future complications, including cirrhosis, liver cancer, or liver failure.

 

Causes

Hepatitis D is caused by the hepatitis D virus. This virus needs hepatitis B virus to propagate, so it can only occur in people who have or had hepatitis B. Transmission can occur through coinfection (both HBV and HDV occurring at the same time) or superinfection (HDV occurring in an individual previously infected with HBV). Hepatitis D virus can spread if a person comes in contact with the blood, semen, or bodily fluids of an infected person. One of the most common modes of transmission of the hepatitis B virus is sexual contact. If you have unprotected sex with an infected person, the virus can enter your body through semen or other secretions.

Another frequent way this virus spreads is by sharing contaminated needles, blades, or razors. Even if a doctor or healthcare worker accidentally gets a needle stick injury after being contaminated with blood, they may contract the virus. Hepatitis D virus can also spread through vertical transmission, i.e., from a pregnant mother to her child. This virus can be passed on to the baby during childbirth.

 

Risk Factors and Epidemiology

The risk of hepatitis D is highest in those who have been infected by hepatitis B virus because HDV cannot cause infection on its own. If you have or had hepatitis B virus and contract hepatitis D virus as well, your liver may suffer through much more damage. Adults have a higher risk of contracting this virus if they have unprotected sex with an infected person. A man having sex with men or having sex with multiple partners also increases the risk. Sharing of contaminated needles or blades, especially among drug abusers, is another risk factor. Birth from an infected mother can also infect the child. Traveling to regions with a high number of active cases may also increase your risk of contracting HDV.

According to a research study, around 16.6% of people who have been infected with hepatitis B virus carry hepatitis D virus as well. The rate of mortality due to the presence of HDV along with HBV is higher compared to HBV alone.

 

Signs and Symptoms

Hepatitis D can exacerbate the symptoms in those who have or had been previously infected by hepatitis B. The signs and symptoms of acute HDV infection are similar to those of other kinds of acute viral hepatitis infections. Symptoms often appear 3–7 weeks after the initial infection and may range from mild to severe. They may include fever, abdominal pain, jaundice, dark urine, clay-colored stools, pain in joints, fatigue, nausea/vomiting, loss of appetite, and generalized weakness.

 

Diagnosis

Your doctor may require a brief history to identify the possible cause. A Physical examination can be done, which will include looking for signs of jaundice and abdominal pain. The conformational diagnosis of hepatitis D can be made by running a blood test for the presence of this virus. As it is not clinically distinguishable from other types of acute viral hepatitis, hepatitis D can only be diagnosed by testing for antibodies to HDV and/or HDV RNA. Anyone who has a positive hepatitis B surface antigen (HBsAg) and is experiencing severe hepatitis symptoms or acute exacerbations should be tested for HDV. HDV infection is diagnosed using anti-HDV immunoglobulin G (IgG), immunoglobulin M (IgM), and serum HDV RNA. Your doctor may perform other tests to check the condition and functioning of your liver, such as LFTs, liver ultrasound, etc. If liver cancer is suspected, a liver biopsy is performed by taking a small sample of your liver tissue.

 

Differential Diagnosis

Hepatitis D should be differentiated from other forms of hepatitis such as hepatitis A, C, E, alcoholic hepatitis, and autoimmune hepatitis. It should also be differentiated from other diseases that cause fever, jaundice, abdominal pain, or gastrointestinal issues. Differentiation can be done on the basis of blood tests for this virus.

 

Treatment

Unfortunately, no vaccine or treatment is available yet for acute or chronic hepatitis D infection. In some acute cases, the infection may clear on its own if your immune system fights off the virus. However, in most cases, the virus persists even after using strong antivirals. Medications can only help reduce symptoms and limit the spread of this infection. If you are tested positive for HDV, avoid unprotected sex or donating your blood to any person. Sharing of common needles, razors or blades should also be avoided. In case your liver has scarred far beyond the limit, your doctor may recommend a liver transplant.

 

Medication

Pegylated Interferon is the only type of medication that can limit the spread of this virus and prevent future complications to some extent. This medication is given for about 12 months and should not be given to patients with decompensated cirrhosis, autoimmune diseases, or active psychiatric conditions because it has considerable side effects. Avoid taking any other medicines without consultation with your doctor, as it may further damage your liver.

 

Prognosis

The mortality rate for individuals affected by the hepatitis D virus is between 2% and 20%. People who already have chronic hepatitis B are at a higher risk of cirrhosis, liver cancer, or liver failure if they get infected by HDV.

 

Prevention

The only way to prevent hepatitis D is to avoid getting infected with hepatitis B virus. Hepatitis B vaccine is the best way to prevent hepatitis B. The vaccine is given in three to four shots over a span of six months. It is suggested for everyone at a high risk of contracting Hep B virus. Apart from vaccines, you should also practice safe sex measures and avoid drug abuse. Healthcare workers should also ask for the history of hepatitis from a patient before beginning an examination.