When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Hepatitis D

Last reviewed: 21 Oct 2024
Last updated: 11 Oct 2023

Summary

Definition

History and exam

Key diagnostic factors

  • jaundice
  • ascites
  • scleral icterus
  • asterixis
Full details

Other diagnostic factors

  • asymptomatic
  • malaise
  • fatigue
  • hepatomegaly
  • fever
  • right upper quadrant tenderness
  • nausea/vomiting
  • arthralgia/arthritis
  • palmar erythema
  • spider nevi
  • splenomegaly
  • loss of secondary sexual characteristics
  • peripheral edema
Full details

Risk factors

  • HBV infection
  • increased likelihood of sexual exposure
  • injection drug use
  • born or living in or travel to geographic regions where HDV is endemic
  • history of incarceration
  • family history of HBV/HDV infection, hepatocellular carcinoma, and/or chronic liver disease
  • perinatal exposure in an infant born to an HDV-infected mother
  • men who have sex with men
  • household contact with HDV infection
  • healthcare workers
  • hemodialysis
Full details

Diagnostic tests

1st tests to order

  • liver biochemistries
  • complete blood count (CBC)
  • basic metabolic panel
  • coagulation profile
  • serum antibody to HDV
  • serum HDV RNA
  • serum hepatitis B surface antigen
  • serum antibody to hepatitis B surface antigen
  • serum antibody to hepatitis B core antigen
  • serum hepatitis B e antigen
  • serum antibody to hepatitis B e antigen
  • serum HBV DNA
  • abdominal ultrasound
Full details

Tests to consider

  • testing for coinfections
  • liver biopsy
  • transient elastography
  • serum liver fibrosis biomarkers
Full details

Treatment algorithm

ACUTE

acute HDV infection

ONGOING

chronic HDV infection

Contributors

Authors

Jawad Ahmad, MD, FRCP, FAASLD

Professor of Medicine

Division of Liver Diseases

Mount Sinai Hospital

New York

NY

Disclosures

JA declares that he has no competing interests.

Anna Maria Geretti, MD, PhD, FRCPath

Professor and Consultant in Virology & Infectious Diseases

Fondazione PTV

University of Rome Tor Vergata

Rome

Italy

North Middlesex University Hospital

London

UK

King’s College London

London

UK

Disclosures

AMG has received personal payments from Abbott, Gilead, GSK, Roche, and ViiV; research funding (to the institution) from Roche and ViiV.

Peer reviewers

Scott Cotler, MD

​Professor of Medicine

Loyola University Chicago

Chicago

IL

Disclosures

SC declares that he has no competing interests.

  • Hepatitis D images
  • Differentials

    • Acute viral hepatitis A
    • Acute viral hepatitis B
    • Acute viral hepatitis C
    More Differentials
  • Guidelines

    • EASL clinical practice guidelines on hepatitis delta virus
    • Viral hepatitis: hepatitis D
    More Guidelines
  • Patient information

    Hepatitis B: should I have the vaccine?

    More Patient information
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer