Hepatitis D
(Redirected from Delta agent)
Hepatitis D is a form of hepatitis that only causes symptoms when the individual is already infected with hepatitis B
Other names[edit | edit source]
Hepatitis D is also known as “delta hepatitis and is caused by hepatitis D virus.
Summary[edit | edit source]
- Hepatitis D is a liver infection caused by the hepatitis D virus (HDV).
- Hepatitis D only occurs in people who are also infected with the hepatitis B virus.
- Hepatitis D is spread when blood or other body fluids from a person infected with the virus enters the body of someone who is not infected. Hepatitis D can be an acute, short-term infection or become a long-term, chronic infection.
- Hepatitis D can cause severe symptoms and serious illness that can lead to life-long liver damage and even death.
- People can become infected with both hepatitis B and hepatitis D viruses at the same time (known as “coinfection”) or get hepatitis D after first being infected with the hepatitis B virus (known as “superinfection”).
- There is no vaccine to prevent hepatitis D.
- Prevention of hepatitis B with hepatitis B vaccine also protects against future hepatitis D infection.
Coinfection and superinfection[edit | edit source]
- HBV/HDV coinfection occurs when a person simultaneously becomes infected with both HBV and HDV, whereas HDV superinfection occurs when a person who is already chronically infected with HBV acquires HDV.
- Although acute HBV/HDV coinfections can resolve, HDV superinfection can lead to rapid progression of the already present HBV infection, resulting in liver cirrhosis and liver failure.
- These outcomes occur within 5–10 years in 70%–80% and within 1–2 years in 15% of people with chronic HBV/HDV infection.
Incidence[edit | edit source]
HDV infection is uncommon in the United States, where most cases occur among people who migrate or travel to the United States from countries with high HDV endemicity. Hepatitis D is most common in Eastern Europe, Southern Europe, the Mediterranean region, the Middle East, West and Central Africa, East Asia, and the Amazon Basin in South America.
Genotypes[edit | edit source]
- Eight different HDV genotypes can be found across the globe, all of which share the same transmission routes and risk groups.
- HDV genotype 1 circulates mainly in North America, Europe, the Middle East, and North Africa.
- HDV genotypes 2 and 4 can be found in East Asia; genotype 3 is found exclusively in the Amazon Basin in South America, and
- HDV genotypes 5, 6, 7, and 8 are found in West and Central Africa.
Transmission and Exposure[edit | edit source]
HDV is mainly transmitted through activities that involve percutaneous (i.e., puncture through the skin) and to a lesser extent through mucosal contact with infectious blood or body fluids (e.g., semen and saliva), including
- sex with an infected partner;
- injection-drug use that involves sharing needles, syringes, or drug-preparation equipment;
- birth to an infected mother (rare);
- contact with blood from or the open sores of an infected person;
- needle sticks or exposures to sharp instruments; and
- sharing items (e.g., razors and toothbrushes) with an infected person.
- HDV is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, hand holding, coughing, or sneezing.
Risk groups[edit | edit source]
The following populations are at increased risk for becoming infected with HDV:
- People chronically infected with HBV
- Infants born to mothers infected with HDV
- Sex partners of persons infected with HDV
- Men who have sex with men
- People who inject drugs
- Household contacts of people with HDV infection
- Health care and public safety workers at risk for occupational exposure to blood or blood-contaminated body fluids
- Hemodialysis patients
Signs and Symptoms[edit | edit source]
HDV causes infection and clinical illness only in HBV-infected people. These include:
- Fever
- Fatigue
- Loss of appetite
- Nausea
- Vomiting
- Abdominal pain
- Dark urine
- Clay-colored bowel movements
- Joint pain
- Jaundice
These signs and symptoms typically appear 3–7 weeks after initial infection.
Clinical course and complications[edit | edit source]
Chronic HDV generally causes a more aggressive and rapid progression of liver disease than chronic HBV infection alone. This is especially evident in patients infected with genotype HDV-3, which is common in the Amazon Basin Of people with chronic HDV superinfection, cirrhosis and liver failure occur within 5–10 years in 70%–80% and within 1–2 years in 15%. Comparatively, the mean age of onset of cirrhosis for people who acquire chronic hepatitis B in childhood is 40 years.
Diagnosis[edit | edit source]
- Because cases of hepatitis D are not clinically distinguishable from other types of acute viral hepatitis, diagnosis can be confirmed only by testing for the presence of antibodies against HDV and/or HDV RNA.
- HDV infection should be considered in any person with a positive hepatitis B surface antigen (HBsAg) who has severe symptoms of hepatitis or acute exacerbations.
Treatment[edit | edit source]
- No treatment is available for HDV infection specifically.
- Pegylated interferon alpha has shown some efficacy, but the sustained virologic response rate (a measure of viral clearance) is low (25%).
- In cases of fulminant hepatitis and end-stage liver disease, liver transplantation may be considered.
Prevention[edit | edit source]
Although no vaccine is available for hepatitis D, vaccination with the hepatitis B vaccine can protect people from HDV infection.
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Contributors: Prab R. Tumpati, MD