Hepatitis D

Hepatitis D virus (HDV) infection affects millions of people globally. Approximately 5% of individuals living with chronic hepatitis B virus (HBV) infection (around 12 million people) have antibodies indicating infection with HDV. The majority have chronic HDV infection.

HDV infection is prevalent in western and mid-Africa, Mongolia, eastern Europe, and parts of the Mediterranean. People at increased risk for HDV infection include those chronically infected with HBV, injection drug users, and those with increased likelihood of sexual exposure.

Chronic HDV infection is the most severe type of chronic viral hepatitis and commonly leads to cirrhosis, liver failure, and hepatocellular carcinoma.

Detection of HDV antibody provides evidence of exposure. Detection of HDV RNA indicates a current infection. The assays are increasingly available, although greater standardization of HDV RNA assays is required. The condition should be monitored with regular liver biochemical tests and liver imaging.

The goal of treatment is to prevent disease progression to end-stage liver disease requiring liver transplant. New treatment options show promise in improving prognosis in patients with chronic infection.

​​HDV is a defective RNA virus that requires HBV surface antigen in order to propagate. It infects susceptible hosts via simultaneous coinfection with HBV or via superinfection of an individual with chronic HBV infection, and is transmitted by percutaneous, permucosal, and sexual routes.[1]European Association for the Study of the Liver. EASL clinical practice guidelines on hepatitis delta virus. J Hepatol. 2023 Aug;79(2):433-60. https://www.doi.org/10.1016/j.jhep.2023.05.001 http://www.ncbi.nlm.nih.gov/pubmed/37364791?tool=bestpractice.com [2]Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018 Apr;67(4):1560-99. https://www.doi.org/10.1002/hep.29800 http://www.ncbi.nlm.nih.gov/pubmed/29405329?tool=bestpractice.com ​​​​ HDV infection (also known as hepatitis delta infection) tends to be more aggressive than other types of viral hepatitis; acute infection may cause acute liver failure, while persistent infection commonly causes a severe chronic hepatitis that can lead to cirrhosis, hepatocellular carcinoma, or liver failure.[1]European Association for the Study of the Liver. EASL clinical practice guidelines on hepatitis delta virus. J Hepatol. 2023 Aug;79(2):433-60. https://www.doi.org/10.1016/j.jhep.2023.05.001 http://www.ncbi.nlm.nih.gov/pubmed/37364791?tool=bestpractice.com