Hepatitis D

Key Features

• Hepatitis D virus (HDV) causes hepatitis only in the presence of hepatitis B surface antigen (HBsAg); it is cleared when the latter is cleared

• May coinfect with hepatitis B virus (HBV) or may superinfect a person with chronic hepatitis B, usually by percutaneous exposure

• As many as 13% of HBV carriers are infected with HDV worldwide; principal risk factors are

  • Injecting drug use

  • High-risk sexual behavior

  • HIV and HCV coinfections

• Three-fold increased risk of hepatocellular carcinoma

• HDV is estimated to cause 18% of cases of cirrhosis and 20% of cases of hepatocellular carcinoma associated with HBV infection

Clinical Findings

• When acute hepatitis D is coincident with acute HBV infection, the infection is generally similar in severity to acute hepatitis B alone

• In chronic hepatitis B, superinfection by HDV appears to carry a worse short-term prognosis, often resulting in acute liver failure or severe chronic hepatitis that progresses rapidly to cirrhosis

Diagnosis

• Made by detecting antibodies to hepatitis D antigen (anti-HDV) or, where available, hepatitis D antigen (HDAg) or HDV RNA in serum

Treatment

• Peginterferon alfa-2b (1.5 mcg/kg/wk for 48 weeks) may lead to normalization of serum aminotransferase levels and histologic improvement, but the sustained virologic response rate is low (25%)

• In addition, peginterferon treatment is associated with significant side effects and should not be given to patients with decompensated cirrhosis, autoimmune diseases, or active psychiatric conditions

• Nucleoside and nucleotide analogs are not effective in treating chronic hepatitis D