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Hepatitis D

Overview

The hepatitis D virus (HDV) causes a liver infection called hepatitis D. It is also known as "delta hepatitis" (HDV). Hepatitis D can only be contracted by people who are simultaneously infected with the hepatitis B virus. Hepatitis D is transmitted when virus-infected blood or other bodily fluids enter the body of an uninfected person. Hepatitis D can be a short-term, acute, or chronic, long-term infection. Hepatitis D can cause severe symptoms as well as liver damage that can last a lifetime and even death. People can get both the hepatitis B and the hepatitis D viruses at the same time, or they can contract hepatitis D after getting the hepatitis B virus. Hepatitis D is not preventable by vaccination. In contrast, hepatitis B immunization protects against future hepatitis D infection.

Causes

You can contract Hepatitis D if you come into contact with the blood or other bodily fluids of someone who has the virus. However, it can only infect you if you have hepatitis B since HDV requires hepatitis "B" strain to survive.

HDV can be caused in one of two ways:

Co-infection: HBV and HDV can both be contracted at the same time.

Super-infection: You can become sick with hepatitis B first, then with HDV later. Hepatitis D is most commonly acquired this way.

Transmission: HDV is transmitted by broken skin (through injection, tattooing, etc.) or contact with infected blood or blood products, similar to HBV. Although transmission from mother to child is possible, it is rare. Hepatitis B vaccine prevents HDV coinfection hence expanding pediatric HBV immunization programs has resulted in a global decline in hepatitis D cases. HDV infection is a risk for chronic HBV carriers. People who are not immune to HBV are at risk of contracting HBV, which puts them at risk of getting HDV.

HBV and HDV co-infection are more common in indigenous people, those who use drugs, and people with hepatitis C or HIV. Co-infection appears to be more likely among hemodialysis patients, males who have sex with other men, and commercial sex workers.

Signs and Symptoms

Only HBV-infected people are infected with HDV, which causes infection and clinical disease. Acute HDV infection has signs and symptoms similar to other kinds of acute viral hepatitis infections. The signs and symptoms usually occur 3–7 weeks after the initial infection. These are some of them:

  • Yellow discoloration of skin and eyes (Jaundice)
  • Fever
  • Nausea and vomiting
  • Abdominal Pain or discomfort ( right upper region)
  • Itching
  • Fatigue and weakness
  • Dark urine
  • Clay-colored stools
  • Loss of appetite
  • Joint pain 

Risk Factors

The following are at a higher risk of contracting HDV:

  • People who have been infected with HBV for a long time.
  • Infants born to mothers who have been infected with HDV.
  • HDV-infected people's sex partners.
  • Men who engage in sexual intercourse with other men.
  • Individuals who inject drugs.
  • Household contacts of people who have been infected with HDV.
  • Workers in the healthcare and public-safety sectors are at risk of being exposed to blood or blood-contaminated bodily fluids.
  • Patients undergoing hemodialysis.

Diagnosis

Hepatitis D can only be diagnosed by testing for antibodies to HDV and/or HDV RNA because it is not clinically distinguishable from other types of acute viral hepatitis. Any person with a positive hepatitis B surface antigen (HBsAg) who has severe hepatitis symptoms or acute exacerbations should be tested for HDV infection. Anti-HDV immunoglobulin G (IgG), immunoglobulin M (IgM), and serum HDV RNA are used to diagnose HDV infection. 

Treatment

There is currently no specific treatment for HDV infection. Pegylated interferon alfa is the most commonly prescribed drug. Although Pegylated interferon-alpha has shown some efficacy, but the rate of sustained virologic response (a measure of viral clearance) is low (25 percent). Irrespective of the patient's response, treatment should last at least 48 weeks. The virus has a low response rate to treatment, although it is linked to a lower risk of disease progression. Patients with decompensated cirrhosis, active psychiatric conditions, or autoimmune diseases should not receive this medication because it has considerable side effects. More effort is required to lower the global burden of chronic hepatitis B and create safe and effective medicines against hepatitis D affordable enough to be distributed widely to those who need them the most.

New treatments are being tried. Liver transplantation may be considered in cases of fulminant hepatitis and end-stage liver disease.

Complications

Chronic Hepatitis D can lead to :

Prevention

While the World Health Organisation (WHO) does not have specific recommendations for hepatitis D, prevention of HBV transmission through hepatitis B immunization, which includes a timely birth dose, additional antiviral prophylaxis for eligible pregnant women, blood safety, safe injection practices in health care settings, and harm reduction services with clean needles and syringes, is effective in preventing HDV transmission. For those who have already been infected with HBV, hepatitis B vaccination does not provide protection against HDV.

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