Last reviewed: 23 Jun 2024
Last updated: 11 Oct 2023
Summary
Definition
History and exam
Key diagnostic factors
- presence of risk 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 naevi
- splenomegaly
- loss of secondary sexual characteristics
- peripheral oedema
Full details
Risk factors
- HBV infection
- increased likelihood of sexual exposure
- injection drug use
- born or living in or travel to geographical 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
- haemodialysis
Full details
Diagnostic investigations
1st investigations to order
- liver biochemistries
- full blood count (FBC)
- renal function tests
- 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
Investigations to consider
- testing for co-infections
- 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?
More Patient informationLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer