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Hepatitis D – Causes, Symptoms and Treatment
Hepatitis D is a liver disease caused by the hepatitis D virus (HDV), which can only occur in people already infected with hepatitis B. It may take an acute or chronic course.
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Hepatitis D is a liver disease caused by the hepatitis D virus (HDV), which can only occur in people already infected with hepatitis B. It may take an acute or chronic course.
What is Hepatitis D?
Hepatitis D (also known as delta hepatitis) is an inflammation of the liver caused by the hepatitis D virus (HDV). A unique characteristic of this virus is that it can only survive and replicate in the presence of the hepatitis B virus (HBV), making HDV a so-called satellite virus. Infection with HDV occurs either simultaneously with an HBV infection (coinfection) or as an additional infection in a person who already has chronic hepatitis B (superinfection).
Causes and Transmission
The hepatitis D virus is primarily transmitted through direct contact with infected blood. The most common routes of transmission include:
- Sharing needles or syringes (intravenous drug use)
- Unprotected sexual intercourse
- Mother-to-child transmission during childbirth
- Contact with infected blood or blood products
Since HDV depends entirely on HBV, only individuals who are already infected with hepatitis B or who become co-infected simultaneously are at risk.
Forms of Hepatitis D Infection
Coinfection
A coinfection occurs when both HBV and HDV are transmitted at the same time. In most cases, this form resolves on its own, but it can occasionally lead to a severe acute course.
Superinfection
A superinfection occurs when a person who already has chronic hepatitis B additionally acquires HDV. This form frequently leads to a chronic course and carries a significantly higher risk of serious liver disease.
Symptoms
The symptoms of hepatitis D are similar to those of other forms of hepatitis and may include:
- Fatigue and general exhaustion
- Jaundice (icterus) – yellowing of the skin and eyes
- Dark urine and pale stools
- Nausea, vomiting, and loss of appetite
- Upper abdominal pain (especially in the liver area)
- Joint pain
In some cases, the infection may initially cause few or no symptoms. Chronic cases can lead to liver cirrhosis or hepatocellular carcinoma over the long term.
Diagnosis
The diagnosis of hepatitis D is established through blood tests. The following parameters are examined:
- Anti-HDV antibodies: Detection of a current or past infection
- HDV RNA: Direct detection of the virus using a PCR test (indicates active viral replication)
- HBsAg: Confirmation of concurrent hepatitis B infection
- Liver enzymes (e.g., ALT, AST) to assess liver damage
- Liver ultrasound if structural changes are suspected
Treatment
Treatment of hepatitis D is more challenging than that of other hepatitis types, as HDV depends on HBV for its replication. Available treatment options include:
- Pegylated interferon-alpha: The previous standard of care, which can inhibit viral replication, although complete viral clearance is achieved in only a minority of patients.
- Bulevirtide (Hepcludex): A novel entry inhibitor approved in the EU since 2020 specifically for the treatment of chronic hepatitis D. It blocks the entry of both HDV and HBV into liver cells.
- Treatment of the underlying hepatitis B, as effective suppression of HBV also limits HDV replication.
Prevention
Since HDV can only exist alongside HBV, vaccination against hepatitis B effectively protects against hepatitis D as well. For individuals already living with hepatitis B, the following protective measures are important:
- Avoiding shared needles or syringes
- Using barrier protection during sexual activity
- Education about transmission routes
References
- World Health Organization (WHO): Hepatitis D Fact Sheet. Available at: https://www.who.int/news-room/fact-sheets/detail/hepatitis-d (2023)
- European Association for the Study of the Liver (EASL): EASL Clinical Practice Guidelines on hepatitis delta virus infection. Journal of Hepatology, 77(3), 799-814 (2023)
- Terrault N.A. et al.: Hepatitis D – Current and Emerging Therapies. Hepatology, 75(4), 1027-1041 (2022)
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