Hepatitis D infection: Symptoms, Transmission, Treatment and Diagnosis

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What is Hepatitis D?

Hepatitis D is an inflammation of the liver cells caused by a microorganism known as the Hepatitis D Virus (HDV). It can cause Hepatitis D infection; this infection does not occur on its own but coexist with Hepatitis B virus (HBV) and can only cause severe infection on those with Hepatitis B infection. When it causes infection at the same time with Hepatitis B, it is known as Co-Infection; when it causes infection following Hepatitis B infection, it is known as Super-infection. Chronic HBV carriers are at risk of having HDV.

Incubation period for superinfection with Hepatitis D takes 2 to 8 weeks for symptoms to manifest but coinfection has an incubation period the same as Hepatitis B which is about 45 to 160 days.

Hepatitis D Virus morphology

Discovered in 1977 by Mario Rizzetto of Italy and colleagues, Hepatitis D virus is a single stranded defective RNA virus that requires Hepatitis B surface antigens (HBsAg) for its transmission and it is also called the Delta agent because it has a protein known as the delta antigen; it is sensitive to formalin. Hepatitis D has an unassigned viral Family.

Yellowish eyes (Jaundice) is one of the symptoms of Hepatitis D and also a symptom of other types of Hepatitis
Yellowish eyes (Jaundice) is one of the symptoms of Hepatitis D and also a symptom of other types of Hepatitis

 

Epidemiology of Hepatitis D

Hepatitis D is endemic in the Middle East, northern parts of South America and Central Africa

Hepatitis D symptoms and signs

The symptoms of Hepatitis D are similar as that ofother Hepatitides such as Hepatis A, B, or Hepatitis Cinfection and include:

  1. Yellowish discoloration of eyes and skin (known as jaundice)
  2. Fever
  3. Abdominal pains
  4. Dark urine
  5. Vomiting
  6. Poor appetite
  7. Joint pains
  8. Fatigue
  9. Some people may have no symptoms
Worldwide epidemiology of Hepatitis D Virus infection according to viral genotype: the genotype 1 is the most frequent Hepatitis D genotype globally whereas genotype 2 is common in the Far East, while genotype 3 is seen exclusively in the northern part of South America
Worldwide epidemiology of Hepatitis D Virus infection according to viral genotype: the genotype 1 is the most frequent Hepatitis D genotype globally whereas genotype 2 is common in the Far East, while genotype 3 is seen exclusively in the northern part of South America

 

Hepatitis D Characteristics

  1. It only infects when you have Hepatitis B
  2. It is also known as the Delta agent
  3. It can cause coinfection or superinfection

Hepatitis D Transmission

How do you get infected with Hepatitis D?

People do get Hepatitis D when they become infected by Hepatitis B infection because it cannot infect you unless you have once had Hepatitis B or you are currently having Hepatitis B. It is a blood borne infection; transmission from mother to child during pregnancy is not common.

People at risk of getting Hepatitis D infection

  1. Having multiple sexual partners
  2. Those who have chronic liver disease cause by HBV
  3. Those who use intravenous drugs (injection drug abusers)
  4. People having kidney disease that are undergoing hemodialysis
  5. Those receiving blood transfusion or blood products such as hemophiliacs

These are the high risk group because they have a higher chance of getting infected by Hepatitis B and hence with Hepatitis D too.

Hepatitis D laboratory diagnosis

Serological test for detecting antibodies against the Hepatitis D virus helps in making a diagnosis of Hepatitis D infectionPeople with Hepatitis D virus RNA in their blood are infectious.

Complications of Hepatitis D

Being coinfected with Hepatitis D increases the risk of liver damage such as liver cirrhosis, liver failure and liver cancer (hepatocellular carcinoma) that are caused by Hepatitis B; this can also lead to death or need for liver transplant.

Hepatitis D Treatment drugs

Some drugs such as pegylated interferon alpha (PEG-IFN-alpha) are used for management of Hepatitis D and can clear the virus in about 15 to 25 people out of 100 infected with the virus. The treatment last for 48 weeks (about a year).

Novel treatments for Hepatitis D include:

Lonafarnib: a prenylation inhibitor that blocks the combination of the Hepatitis B surface antigen with the Hepatitis D antigen.

Myrcludex B: this blocks the receptor necessary for a specific transport protein

Hepatitis D Prevention

There is no vaccine for Hepatitis D but when you take vaccines for Hepatitis B, it provides protection from Hepatitis D because it cannot infect you without the presence of Hepatitis B. other means of prevention entails you avoid any thing that aids transmission such as:

  1. Avoid sharing of needles or razor blades
  2. Disinfect all items that have come in contact with blood
  3. Avoid sexual promiscuity

 

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