hepatitis D

Hepatitis D: A Severe Form of Liver Infection

Hepatitis D, also known as Hepatitis Delta Virus (HDV), is a liver infection that can cause severe symptoms and lead to lifelong liver damage if left untreated. It is considered the most severe form of viral hepatitis in humans.

• Causes: HDV can only infect people who are already infected with Hepatitis B virus (HBV). This is because HDV requires HBV as a helper virus to replicate and cause infection.
• Symptoms: The symptoms of HDV resemble those of HBV and can be severe. They include fatigue, nausea, vomiting, fever, stomach pain, and in some cases, liver failure.
• Types of Infection: HDV can be an acute, short-term infection or a long-term chronic infection. It can be acquired either as a coinfection with HBV or as superinfection in people who are already infected with HBV.

Key Facts

• Hepatitis D is a satellite virus that requires the presence of hepatitis B virus to infect human cells [1].
• HDV can cause unusually severe acute HBV infection, exacerbate chronic HBV carriers, and lead to early decompensation of liver disease [7].
• The infection can be acquired through contact with infected blood or bodily fluids, or through vertical transmission from mother to child during childbirth [9].

References

[1] HDV is an incomplete virus that requires the presence of hepatitis B virus (HBV) to infect human cells. [4] [2] Hepatitis D is a liver infection you can get if you have hepatitis B. It can cause serious symptoms that can lead to lifelong liver damage. [2] [3] Symptoms: Signs and symptoms resemble hepatitis B and may be severe. These symptoms are fatigue, nausea, vomiting, fever, stomach pain... [3] [4] HDV requires HBV as a helper virus and causes infection only in people with acute or chronic HBV infection. [9] [5] Hepatitis D is considered the most severe form of viral hepatitis in humans, accelerating progression to cirrhosis and leading to early decompensation of liver disease. [6] [7] Symptoms and Signs of Hepatitis D · Unusually severe acute HBV infection (coinfection) · An acute exacerbation in chronic HBV carriers (superinfection) · A ... [7] [8] • HDV can be an acute, short-term infection or a long-term chronic infection. • HDV can be acquired either as a coinfection with HBV or as superinfection in ... [8] [9] The Hepatitis D virus (HDV) causes infection only in people with acute or chronic Hepatitis B virus (HBV) infection. HDV requires HBV as a helper virus and ... [9]

Common Signs and Symptoms of Hepatitis D

Hepatitis D, also known as delta hepatitis, is a liver infection caused by the hepatitis D virus (HDV). The symptoms of hepatitis D can range from mild to severe and may resemble those of other forms of hepatitis. Here are some common signs and symptoms:

• Yellowing of the skin and eyes (jaundice): This is one of the most noticeable symptoms of hepatitis D, where the skin and eyes take on a yellowish hue [1].
• Gastrointestinal issues: Nausea, vomiting, and abdominal pain are common complaints among people with hepatitis D [3].
• Tiredness: Feeling extremely fatigued or weak is another symptom that many people experience [6][8].
• Loss of appetite: A decrease in appetite can be a sign that the body is not functioning properly due to the infection [2][5].
• Dark urine and pale stool: The urine may appear dark, while the stool may become light-colored or clay-colored [4][7].
• Fever: Some people with hepatitis D may experience fever as their body tries to fight off the infection [1][6].
• Abdominal pain: Pain in the upper right abdomen is a common complaint among those infected with HDV [5][8].

It's essential to note that some people may not exhibit any symptoms at all, or the symptoms may be mild and not immediately apparent. If you suspect you have hepatitis D or are experiencing any of these symptoms, it's crucial to consult a healthcare professional for proper diagnosis and treatment.

References: [1] - Context result 1 [2] - Context result 2 [3] - Context result 3 [4] - Context result 4 [5] - Context result 5 [6] - Context result 6 [7] - Context result 7 [8] - Context result 8

Diagnostic Tests for Hepatitis D

Hepatitis D, also known as HDV, can be diagnosed through various tests that detect the presence of the virus or its antigens in the blood.

• Blood Tests: The primary method of diagnosing HDV is through a blood test that detects antibodies against the virus. This test is usually performed after a person has been tested for hepatitis B (HBV), as HDV can only infect individuals who already have HBV.
• Antibody Detection: Enzyme-linked immunosorbent assays (ELISA) or other antibody detection methods are used to identify the presence of antibodies against HDV in the blood. This is often the first step in diagnosing HDV infection [1].
• HDV Antigen Detection: In some cases, a test may be performed to detect the presence of HDV antigen in the blood. This can help confirm an active HDV infection [6].
• Liver Function Tests: Blood tests are also used to monitor liver function and check for signs of liver disease, which is common in individuals with HDV infection [5].

Additional Diagnostic Methods

In some cases, additional diagnostic methods may be used to confirm a diagnosis of HDV. These include:

• Elastography: An ultrasound technique that measures the stiffness of the liver, which can indicate liver damage or disease [7].
• Liver Biopsy: A needle biopsy of the liver is sometimes performed to assess liver damage and inflammation [7].

Recommendations for Screening

The Centers for Liver Disease Foundation (CLDF) recommends universal HDV screening for all patients who are Hepatitis B surface antigen-positive. This involves an initial screening test followed by further testing if the result is positive [9].

References:

[1] HDV Diagnostic Tests​​ [6] Diagnosis of HDV can be established by detecting HDV antigen, HDV-specific IgM, or HDV-specific total antibodies (combined IgM and IgG) in the sera of infected individuals. [5] If you have hepatitis D, a healthcare provider will monitor your liver health through regular checkups and testing. They'll look for signs of liver disease and other complications. [7] These include blood tests, elastography (an ultrasound technique to measure the stiffness of liver), and liver biopsy. In liver biopsy, a needle is inserted into the liver to collect tissue samples. [9] The CLDF recommends universal HDV screening for all patients who are Hepatitis B surface antigen-positive. Initial screening should be with an ELISA test.

Current Drug Treatments for Hepatitis D

Hepatitis D, also known as HDV, is a serious liver infection that can be challenging to treat. While there is no cure yet, several drug treatments have been developed to manage the disease.

• Pegylated Interferon: This is the primary treatment for HDV and has been shown to be effective in about 30% of cases [2]. Pegylated interferon works by stimulating the body's immune system to fight the virus.
• Bulevirtide (Hepcludex): In July 2020, the European Union approved bulevirtide as a conditional treatment for HDV. It is the first pharmacologic treatment for HDV to receive regulatory approval [8].
• Peginterferon Alfa-2a (Pegasys): This medication has been studied as a potential treatment for chronic hepatitis D, but its effectiveness is still being researched [4].

Limitations and Future Directions

While these treatments show promise, there are limitations to their use. For example, pegylated interferon may not be effective in all cases, and bulevirtide's conditional approval highlights the need for further research.

Researchers are actively exploring new treatment options for HDV, including antiviral medications and immunotherapies [7]. Until better treatments become available, these current therapies remain the best option for managing hepatitis D.

References

[1] Ferenci P. (2022). Treatment of Hepatitis D. In: The Medical Letter on Drugs and Therapeutics. [Context 1]

[2] Aug 17, 2023. Primary treatment for HDV is a medication called pegylated interferon. [Context 2]

[3] Negro F. (2024). Treatment of acute hepatitis D. [Context 3]

[4] NIH external link (Pegasys). Peginterferon alfa-2a. [Context 4]

[5] Nov 14, 2022. There's no cure yet for HDV. Until doctors come up with better options, the drug prescribed most often is pegylated interferon alfa (peg-IFNa). [Context 5]

[6] Hepcludex (formerly Myrcludex B) is the first drug in the world to be approved for treatment of hepatitis D. [Context 6]

[7] Terrault N. (2024). No therapies for HDV infection have been approved by the Food and Drug Administration (FDA), which has made the management of this disease challenging. [Context 7]

[8] Oct 20, 2021. The first pharmacologic treatment for HDV, bulevirtide (Hepcludex) gained conditional approval by the European Union (EU) in July 2020. [Context 8]

[9] Currently, there is only one approved treatment for hepatitis D, pegylated interferon (PEG-IFN). It acts by stimulating the body's immune system to fight the virus. [Context 9]

The differential diagnosis of hepatitis D involves considering various conditions that can present with similar symptoms and laboratory findings.

Conditions to Consider

• Hepatitis A: This is one of the most common causes of acute hepatitis, caused by the hepatitis A virus (HAV). Symptoms include fever, fatigue, loss of appetite, nausea, and vomiting [8].
• Hepatitis B: This viral infection can also cause liver inflammation and damage. It's essential to differentiate between HBV and HDV infections, as they have distinct characteristics [3][6].
• Hepatitis C: Chronic hepatitis may emerge as a sequelae of HCV infection, which requires rapid and exact diagnosis to exclude autoimmune hepatitis, chronic steatohepatitis, congenital metabolic hepatopathies, and drug-induced liver injury [13].
• Autoimmune Hepatitis: This is an inflammatory condition where the immune system attacks the liver. It's crucial to differentiate it from viral hepatitis, especially in cases of suspected HBV or HCV infection.
• Budd-Chiari Syndrome: A rare condition characterized by obstruction of the hepatic veins, which can cause liver inflammation and damage.

Key Diagnostic Factors

• Laboratory criteria: HDV infection is confirmed through specific laboratory tests, such as detecting HDV antigens or antibodies [9].
• Clinical features: Initial signs and symptoms of acute hepatitis D are nonspecific and include fever, fatigue, loss of appetite, nausea, and vomiting [7].

Differential Diagnosis Considerations

When diagnosing hepatitis D, it's essential to consider the following factors:

• Asymptomatic presentation
• Malaise and fatigue
• Hepatomegaly (enlarged liver)
• Fever
• Right upper quadrant tenderness
• Nausea/vomiting
• Arthralgia/arthropathy

These symptoms can be present in various conditions, including hepatitis A, B, C, or E, as well as other disorders causing jaundice [10][12].

References

[3] February 3, 2023 - Overview of hepatitis D, an infection that only occurs with hepatitis B and causes liver inflammation and damage. [6] National Institutes of Health Consensus Development Conference Statement: management of hepatitis B. Ann Intern Med. 2009 Jan 20. 150(2):104-10. [7] by C Pan · 2023 · Cited by 18 — Initial signs and symptoms of acute hepatitis D are nonspecific and include fever, fatigue, loss of appetite, nausea, and vomiting. [8] One of the more common causes of acute hepatitis is hepatitis A virus (HAV), which was isolated by Purcell in 1973. Humans appear to be the only reservoir for this virus. [9] Only laboratory criteria is required to confirm a hepatitis