Hepatitis D

Symptoms of Hepatitis D

The symptoms of different types of hepatitis are generally similar; however, symptoms experienced by patients with hepatitis D are often more severe because they are also infected with hepatitis B. This dual infection places additional strain on the liver, intensifying the impact of the symptoms.

Here are the symptoms that may be experienced by individuals with hepatitis D:

1. Jaundice or yellowing of the skin and eyes. This common symptom occurs due to high bilirubin levels caused by liver inflammation.
2. Pain in the upper right abdomen. Hepatitis D can cause discomfort in the upper right side of the abdomen where the liver is located, indicating liver inflammation.
3. Fever. A mild to moderate fever is common as the body responds to the infection.
4. Nausea and vomiting. Digestive discomfort, including nausea and vomiting, is a frequent symptom as the liver struggles to process toxins.
5. Loss of appetite. A decreased appetite often accompanies the infection, potentially leading to weight loss.
6. Severe fatigue. Hepatitis D can cause extreme tiredness due to the liver’s compromised ability to function effectively.
7. Dark urine. Elevated bilirubin levels may cause urine to appear unusually dark.
8. Grayish stool. Due to liver dysfunction, bile production may be disrupted, resulting in pale or gray-colored stool.
9. Unintentional weight loss. Rapid weight loss may occur due to loss of appetite and ongoing nausea.
10. Abdominal bloating or swelling. In advanced cases, fluid buildup (ascites) may cause the abdomen to swell, leading to discomfort and a feeling of fullness.
11. Swelling of the legs. Hepatitis D can cause fluid retention, resulting in swelling of the lower limbs.

These symptoms often indicate liver distress and should prompt immediate medical evaluation, particularly for individuals already diagnosed with hepatitis B. Monitoring symptoms and seeking treatment can help manage the progression of the infection and reduce the risk of severe liver complications.

Types of Hepatitis D

Hepatitis D is divided into two main types based on the duration and progression of the liver infection. These are:

1. Acute hepatitis D. In acute hepatitis D, the liver infection is short-term, usually lasting several weeks to a few months. The symptoms are similar to other types of hepatitis but tend to be more severe due to the dual infection with hepatitis B. In some cases, the body’s immune system can successfully fight off the virus, and the infection resolves on its own without causing long-term damage.
2. Chronic hepatitis D. Chronic hepatitis D occurs when the infection becomes long-term, persisting for six months or more. This type poses a greater risk to liver health, as the ongoing infection can lead to serious complications, such as liver scarring (fibrosis), cirrhosis, and even liver failure over time. Chronic hepatitis D is more challenging to manage, often requiring ongoing medical monitoring and supportive treatments.

Patients with chronic hepatitis D face a higher risk of liver-related complications than those with acute infections. Early diagnosis and appropriate medical care are essential to manage symptoms and reduce the progression of liver damage.

Diagnostic Procedures for Hepatitis D

Diagnosing hepatitis D involves specific blood tests to detect the hepatitis D virus (HDV) and evaluate the health of the liver. Since hepatitis D only infects those with hepatitis B, diagnostic testing also confirms hepatitis B status. Here are the main diagnostic procedures used for hepatitis D:

1. Medical history and physical examination. A healthcare provider will first take a detailed medical history, asking about potential exposure risks, such as unprotected sexual contact, needle sharing, or travel to areas with high hepatitis D prevalence. They will also perform a physical exam to check for signs of liver disease, such as jaundice, abdominal tenderness, and liver enlargement.
2. Hepatitis B and D antibody tests. Since HDV can only infect those with hepatitis B, testing first confirms hepatitis B infection by detecting HBV surface antigens in the blood. Hepatitis D antibody testing then identifies the presence of HDV antibodies (anti-HDV), which indicate exposure to HDV. A positive anti-HDV result suggests a current or past infection.
3. HDV RNA test. To confirm an active hepatitis D infection, an HDV RNA test is conducted, usually through polymerase chain reaction (PCR). This test detects the genetic material of HDV in the blood, verifying an active infection. The HDV RNA test is especially important in distinguishing between past exposure and current infection.
4. Liver function tests (LFTs). Liver function tests measure liver enzymes, bilirubin, and proteins in the blood, helping assess the degree of liver inflammation and damage caused by HDV. Elevated liver enzyme levels, such as ALT and AST, typically indicate liver inflammation or injury.
5. Liver ultrasound. An ultrasound may be used to evaluate liver size, shape, and structure. This imaging test is particularly helpful in identifying advanced liver damage, such as cirrhosis or fibrosis, which may occur in chronic hepatitis D infections.
6. Liver biopsy. In some cases, a liver biopsy is performed to obtain a small tissue sample from the liver. This procedure helps assess the severity of liver damage, identify fibrosis or cirrhosis, and guide treatment decisions, particularly for patients with chronic hepatitis D.

Early diagnosis and monitoring through these diagnostic procedures are essential for managing hepatitis D. By assessing liver function and confirming HDV infection, healthcare providers can tailor treatment plans, monitor progression, and address potential complications in those affected by this serious liver infection.

Complications of Untreated Hepatitis D

When left untreated, hepatitis D can lead to severe and often life-threatening complications, primarily due to its rapid progression and high risk of liver damage, especially in individuals co-infected with hepatitis B. Below are the most common complications associated with untreated hepatitis D:

1. Cirrhosis. Chronic hepatitis D can lead to cirrhosis, where healthy liver tissue is replaced with scar tissue. This scarring reduces liver function, impairs blood flow through the liver, and can cause serious health problems.
2. Liver failure. Over time, extensive liver damage from hepatitis D may result in liver failure, where the liver loses its ability to perform vital functions. Liver failure may lead to fluid buildup, bleeding disorders, and toxins accumulating in the body, and often requires a liver transplant.
3. Hepatocellular carcinoma (liver cancer). Untreated hepatitis D is associated with a heightened risk of liver cancer, particularly hepatocellular carcinoma. Chronic inflammation from HDV and HBV co-infection can trigger cell mutations that lead to cancer.
4. Portal hypertension. Cirrhosis from hepatitis D can cause portal hypertension, a condition where high blood pressure in the liver’s portal vein system leads to complications such as varices (swollen veins) in the esophagus and stomach, which can rupture and cause life-threatening bleeding.
5. Ascites and edema. Fluid retention in the abdomen (ascites) and legs (edema) is a common complication of liver disease. Ascites can lead to painful abdominal swelling, infections, and difficulty breathing, significantly impacting quality of life.
6. Encephalopathy. Advanced liver disease from untreated hepatitis D can lead to hepatic encephalopathy, a condition where toxins build up in the blood and reach the brain. This can cause confusion, disorientation, personality changes, and in severe cases, coma.

Proper management of hepatitis D through early diagnosis and monitoring can help reduce these risks and prevent long-term damage. Individuals with hepatitis D should receive regular medical care to manage liver health, monitor for complications, and consider treatment options, which can significantly improve their prognosis and quality of life.

Causes of Hepatitis D

The direct cause of hepatitis D is the hepatitis D virus (HDV), a defective virus that requires the presence of the hepatitis B virus (HBV) to replicate and cause infection. The infection occurs when HDV enters the body and reaches the liver through bodily fluids from an infected person. The actual causes of hepatitis D transmission include the following:

1. Introduction of HDV through contaminated blood. Direct exposure to infected blood, such as through a transfusion of unscreened or improperly handled blood products, can introduce HDV into the body.
2. Direct injection of HDV via contaminated needles or syringes. This occurs when syringes or needles contaminated with the virus are reused or shared, leading to direct introduction of the virus into the bloodstream. This is particularly common in healthcare settings or among individuals who inject drugs.
3. Transfer of HDV from mother to child during pregnancy. Vertical transmission can occur when an infected mother passes the virus to her unborn child, especially if the mother is co-infected with HBV. This occurs directly as the virus crosses the placenta.
4. Direct mucosal contact during unprotected sexual activities. The virus can directly enter the bloodstream through mucosal microtears during unprotected sexual contact with an infected person.

These direct causes highlight how HDV enters and spreads within the body. Preventing hepatitis D requires strategies that block these direct transmission pathways, such as using sterile medical equipment, practicing safe sex, and ensuring proper blood screening protocols.

Prevention of Hepatitis D

Hepatitis D is relatively easy to prevent, especially if the following precautions are taken:

1. Get vaccinated with the hepatitis B vaccine. Since hepatitis D cannot occur without a hepatitis B infection, receiving the hepatitis B vaccine effectively prevents hepatitis D. This is especially important for those who were not vaccinated in infancy or childhood, as vaccination provides immunity against hepatitis B and, by extension, hepatitis D.
2. Use protection during sexual activity. When engaging in sexual activities with a partner whose health history is not fully known, using protection such as condoms can prevent the transmission of bodily fluids, reducing the risk of exposure to HDV through intimate contact.
3. Avoid illicit drug use. Many injectable illicit drugs require shared needles, increasing the risk of blood-borne infections like HDV. Avoiding drug use reduces this risk significantly, especially for drugs like heroin or cocaine, which are commonly injected and may involve needle-sharing.
4. Wear gloves in medical settings. For healthcare professionals, strict adherence to hospital protocols, such as wearing gloves when drawing blood samples, is essential to avoid accidental contact with infected blood. Wearing thick gloves further reduces the risk of accidental needle sticks, especially when handling sharp objects.

By following these preventive measures, individuals can greatly reduce their risk of contracting both hepatitis B and hepatitis D. Proper vaccination, safe practices, and adherence to safety protocols in healthcare settings are all critical components in reducing the spread of HDV.

Risk Factors for Hepatitis D

Although anyone can contract hepatitis D, certain groups have a higher risk of infection due to increased exposure to hepatitis B virus (HBV) or environments where hepatitis D is more prevalent. These high-risk groups include:

1. Patients with hepatitis B. Since hepatitis D requires hepatitis B to survive, individuals already infected with HBV are at a greater risk of also contracting HDV.
2. Unvaccinated individuals. People who have not received the hepatitis B vaccine lack immunity against HBV and, therefore, are more susceptible to co-infection with hepatitis D.
3. People with multiple sexual partners who do not use protection. Those who engage in unprotected sex with multiple partners face a higher risk of exposure to both HBV and HDV through bodily fluids.
4. Men who have sex with men. Men who engage in sexual activity with other men may have an elevated risk, especially if protection is not consistently used.
5. People who use injectable drugs. The practice of sharing needles or syringes significantly increases the risk of exposure to blood-borne viruses, including HBV and HDV.
6. Infants born to mothers with hepatitis D. Although rare, infants can contract hepatitis D if their mother is co-infected with hepatitis B and D during pregnancy.
7. Healthcare workers. Those who work in healthcare settings, including hospitals, are at increased risk due to their frequent exposure to blood and bodily fluids from patients.
8. Medical waste collectors. Individuals handling medical waste may come into contact with contaminated needles or other materials carrying HDV.
9. Patients requiring frequent blood transfusions. Although blood screening has improved, patients needing regular transfusions still have a slightly elevated risk of contracting hepatitis B and D.
10. Residents in areas with high rates of hepatitis D. People living in regions with high hepatitis D prevalence, such as parts of Eastern Europe, the Middle East, and Africa, are more likely to encounter HDV.

Understanding these risk factors allows for targeted preventive strategies, such as hepatitis B vaccination, safe practices in healthcare and sexual activities, and avoiding needle-sharing. For those in high-risk groups, regular health checkups and education on protective measures are essential in reducing the risk of hepatitis D.

Hepatitis D FAQs

Hepatitis D, also known as hepatitis delta, is a liver infection caused by the hepatitis D virus (HDV). This virus can only infect those who already have hepatitis B, as it requires the hepatitis B virus to replicate. Hepatitis D is known for its potential to cause severe liver damage and rapid progression to complications. Below, we answer some frequently asked questions about hepatitis D to help clarify its causes, symptoms, transmission, and prevention.

1. What is hepatitis D, and how does it affect the liver?
   Hepatitis D is a viral infection of the liver caused by the hepatitis D virus (HDV). It is unique because it requires the presence of hepatitis B virus (HBV) to survive and replicate. When combined with HBV, hepatitis D can cause more severe liver damage, leading to faster progression toward liver disease and potential liver failure.
2. How is hepatitis D transmitted?
   Hepatitis D is transmitted through contact with infected bodily fluids, such as blood, semen, or vaginal fluids. It is most commonly spread through unprotected sex with an infected partner, sharing contaminated needles, or from mother to child during childbirth. HDV cannot be transmitted without HBV, so only individuals with hepatitis B can contract hepatitis D.
3. Who is at risk of hepatitis D?
   People at higher risk include those already infected with hepatitis B, individuals who have not been vaccinated against hepatitis B, people who engage in unprotected sex with multiple partners, individuals who inject drugs, healthcare workers exposed to blood, and those in regions with high hepatitis D prevalence.
4. What are the symptoms of hepatitis D?
   Symptoms of hepatitis D can include jaundice (yellowing of the skin and eyes), fatigue, abdominal pain, nausea, dark urine, loss of appetite, and joint pain. In co-infection with hepatitis B, these symptoms are often more intense and may progress to severe liver complications.
5. Can hepatitis D become chronic?
   Yes, hepatitis D can become chronic, especially in individuals with a weakened immune system. Chronic hepatitis D increases the risk of cirrhosis, liver failure, and liver cancer, and it requires close medical monitoring.
6. Is there a vaccine for hepatitis D?
   While there is no specific vaccine for hepatitis D, getting vaccinated against hepatitis B provides protection, as HDV requires HBV to survive. The hepatitis B vaccine is the most effective prevention against hepatitis D.
7. How is hepatitis D diagnosed?
   Hepatitis D is diagnosed through blood tests that detect HDV antibodies or HDV RNA in the blood. Additional tests may be performed to evaluate liver function and the extent of liver damage.
8. What treatment options are available for hepatitis D?
   Currently, there are limited treatment options specifically for hepatitis D. Antiviral treatments may help some patients, but effectiveness can vary. In severe cases, liver transplantation may be considered. Managing symptoms and closely monitoring liver health are essential for individuals with hepatitis D.
9. How can hepatitis D be prevented?
   Preventive measures include getting the hepatitis B vaccine, practicing safe sex, avoiding needle-sharing, and following safety protocols in healthcare settings. For those already infected with hepatitis B, monitoring liver health and seeking medical advice can help prevent HDV co-infection.