Last reviewed: 5 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.
Differentials
- Acute viral hepatitis A
- Acute viral hepatitis B
- Acute viral hepatitis C
More DifferentialsGuidelines
- EASL clinical practice guidelines on hepatitis delta virus
- Viral hepatitis: hepatitis D
More GuidelinesPatient information
Hepatitis B: should I have the vaccine?
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