Hepatitis D Virus and Infection

Learn About the Symptoms, Treatments and Prevention of Hepatitis D

Hepatitis D infection, which is caused by the hepatitis D virus (HDV), is a disease that infects the liver. It's similar to the other hepatotropic viruses (A, B, C and E) because it causes liver inflammation and produces similar symptoms, but HDV is unusual. It can only infect someone who has hepatitis B. HDV is unable to replicate itself, so to get around this problem, HDV depends on the hepatitis B virus (HBV) for replication (the process of making copies of itself).

What is Hepatitis D Infection Like?

Hepatitis D causes two kinds of infection: coinfection or superinfection. Coinfection is when someone is infected with HBV and HDV at the same time. Superinfection is when someone already has hepatitis B and then is infected with HDV. 

Coinfection is usually acute, and will resolve by itself. Superinfection has the possibility of being more serious. With superinfections, mild cirrhosis from hepatitis B can become severe and progressive cirrhosis (scarring of the liver). Some cases will lead to fulminant hepatitis.

Do I Have Hepatitis D?

The only way to tell if you have hepatitis D is by a blood test. Typically, doctors look for hepatitis D in people who have severe or rapidly progressive hepatitis B. In these cases, doctors will test your blood for various markers of acute or chronic HDV infection. Based on the pattern of your disease and the results of your blood tests for HBV and HDV, doctors can estimate whether your infection is acute, chronic or a superinfection.

What are the Symptoms?

Typically, the search for hepatitis D only happens when your hepatitis is severe or is getting worse. Any symptoms are similar to the other acute viral hepatitis diseases, just probably more severe. Regardless, with hepatitis D, the course of infection is determined by the HBV infection. Hepatitis D can't last longer than the hepatitis B infection.

How is Hepatitis D Spread?

Hepatitis D is spread similar to hepatitis B, which is by direct contact with infected blood. It is relatively rare in the United States and other developed countries. In these areas, hepatitis D is found most commonly in IV drug users. There is also an association with poor hygiene. Countries with higher rates of hepatitis D infection among HBV carriers include those around the Mediterranean Sea, the Middle East and Sub-Saharan Africa.

How is Hepatitis D Treated?

Chronic treatment for hepatitis D usually involves interferon therapy. The antiviral medications used in treating hepatitis B aren't effective for hepatitis D. If the chronic disease progresses to liver failure a liver transplant may be necessary. The results of transplantation for hepatitis D are usually better than for hepatitis B.

Though treatment may be necessary, it's usually relatively expensive and will have side effects. Because of this, it's best to try and prevent infection in the first place.

How Can I Prevent Hepatitis D?

There is no vaccine for hepatitis D, but you can prevent HDV infection by getting vaccinated for hepatitis B. Because HDV needs HBV to make copies of itself, by avoiding hepatitis B, you will avoid hepatitis D.

For those with chronic hepatitis B infection (or those with HBsAg in their blood), there is no vaccine, but avoiding direct contact with infected blood will prevent exposure to hepatitis D. This would include sharing dirty needles, having unprotected sex, and sharing personal items that may have infected blood on them such as razors and toothbrushes.


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Article Sources

  • Centers for Disease Control and Prevention. July 10, 2008. Viral Hepatitis.
  • Dienstag, JL. Acute Viral Hepatitis. In: AS Fauci, E Braunwald, DL Kasper, SL Hauser, DL Longo, JL Jameson, J Loscaizo (eds), Harrison’s Principles of Internal Medicine, 17e. New York, McGraw-Hill, 2008.
  • Perrillo, R and Nair, S. Hepatitis B and D. In: M Feldman, LS Friedman, LJ Brandt (eds), Gastrointestinal and Liver Disease, 8e. Philadelphia, Elsevier, 2006. 1647-1672.