Hepatitis D

What is hepatitis D?

Hepatitis D is a viral infection that causes liver inflammation and damage. Inflammation is swelling that occurs when tissues of the body become injured or infected. Inflammation can damage organs.

Viruses invade normal cells in your body. Many viruses cause infections that can spread from person to person.

The hepatitis D virus is unusual because it can only infect you when you also have a hepatitis B virus infection. In this way, hepatitis D is a double infection. You can protect yourself from hepatitis D by protecting yourself from hepatitis B by getting the hepatitis B vaccine.

Hepatitis D spreads the same way that hepatitis B spreads, through contact with an infected person’s blood or other body fluids.

The hepatitis D virus can cause an acute or chronic infection, or both. 

Acute hepatitis D

Acute hepatitis D is a short-term infection. The symptoms of acute hepatitis D are the same as the symptoms of any type of hepatitis and are often more severe.19 Sometimes your body is able to fight off the infection and the virus goes away.

Chronic hepatitis D

Chronic hepatitis D is a long-lasting infection. Chronic hepatitis D occurs when your body is not able to fight off the virus and the virus does not go away. People who have chronic hepatitis B and D develop complications more often and more quickly than people who have chronic hepatitis B alone.20

How do hepatitis D and hepatitis B infections occur together?

Hepatitis D and hepatitis B infections may occur together as a coinfection or a superinfection. People can only become infected with hepatitis D when they also have hepatitis B.

Coinfection

A coinfection occurs when you get both hepatitis D and hepatitis B infections at the same time. Coinfections usually cause acute, or short-term, hepatitis D and B infections. Coinfections may cause severe acute hepatitis.

In most cases, people are able to recover from and fight off the acute hepatitis D and B infections and the viruses go away. However, in less than 5 percent of people with a coinfection, both infections become chronic and do not go away.21

Superinfection

A superinfection occurs if you already have chronic hepatitis B and then become infected with hepatitis D. When you get a superinfection, you may have severe acute hepatitis symptoms.19

Up to 90 percent of people with a superinfection are not able to fight off the hepatitis D virus, and develop chronic hepatitis D.20 As a result, these people will have both chronic hepatitis D and chronic hepatitis B.

How common is hepatitis D?

Hepatitis D is not common in the United States. Hepatitis D is more common in other parts of the world, including Eastern and Southern Europe; the Mediterranean region and Middle East; parts of Asia, including Mongolia; Central Africa; and the Amazon River basin in South America.22,23

Who is more likely to have hepatitis D?

Hepatitis D infection occurs only in people who have hepatitis B. People are more likely to have hepatitis D in addition to hepatitis B if they

What are the complications of acute hepatitis D?

In rare cases, acute hepatitis D can lead to acute liver failure, a condition in which the liver fails suddenly. Although acute liver failure is uncommon, hepatitis D and B infections are more likely to lead to acute liver failure than hepatitis B infection alone.24

What are the complications of chronic hepatitis D?

Chronic hepatitis D may lead to cirrhosis, liver failure, and liver cancer. People who have chronic hepatitis B and D are more likely to develop these complications than people who have chronic hepatitis B alone.20 Early diagnosis and treatment of chronic hepatitis B and D can lower your chances of developing serious health problems.

Cirrhosis

Cirrhosis is a condition in which the liver slowly breaks down and is unable to work normally. Scar tissue replaces healthy liver tissue, partly blocking the flow of blood through the liver. In the early stages of cirrhosis, the liver continues to work. As cirrhosis gets worse, the liver begins to fail.

Liver failure

Also called end-stage liver disease, liver failure progresses over months or years. With end-stage liver disease, the liver can no longer perform important functions or replace damaged cells.

Liver cancer

Having chronic hepatitis B and chronic hepatitis D increases your chance of developing liver cancer. Your doctor may suggest an ultrasound or other type of imaging test to check for liver cancer every 6 months. Finding cancer at an early stage improves the chance of curing the cancer.

What are the symptoms of hepatitis D?

Most people with acute hepatitis D have symptoms, which may include

  • feeling tired
  • nausea and vomiting
  • poor appetite
  • pain over the liver, in the upper part of the abdomen
  • darkening of the color of urine
  • lightening of the color of stool
  • yellowish tint to the whites of the eyes and skin, called jaundice

In contrast, most people with chronic hepatitis D have few symptoms until complications develop, which could be several years after they were infected. Some symptoms of cirrhosis include

  • weakness and feeling tired
  • weight loss
  • swelling of the abdomen
  • swelling of the ankles, called edema
  • itching skin
  • jaundice

What causes hepatitis D?

The hepatitis D virus causes hepatitis D. The hepatitis D virus spreads through contact with an infected person’s blood or other body fluids. Contact can occur by

  • sharing drug needles or other drug materials with an infected person
  • having unprotected sex with an infected person
  • getting an accidental stick with a needle that was used on an infected person

The hepatitis D virus rarely spreads from mother to child during birth.

You can’t get hepatitis D from

  • being coughed on or sneezed on by an infected person
  • drinking water or eating food
  • hugging an infected person
  • shaking hands or holding hands with an infected person
  • sharing spoons, forks, and other eating utensils
  • sitting next to an infected person

How do doctors diagnose hepatitis D?

Doctors diagnose hepatitis D based on your medical history, a physical exam, and blood tests. If you have hepatitis D, your doctor may perform tests to check your liver.

Medical history

Your doctor will ask about your symptoms and about factors that may make you more likely to get hepatitis D.

Physical exam

During a physical exam, your doctor will check for signs of liver damage such as

  • changes in skin color
  • swelling in your lower legs, feet, or ankles
  • tenderness or swelling in your abdomen

What tests do doctors use to diagnose hepatitis D?

Your doctor may order one or more blood tests to diagnose hepatitis D. A health care professional will take a blood sample from you and send the sample to a lab.

Blood test

Your doctor may order one or more blood tests to diagnose hepatitis D. A health care professional will take a blood sample from you and send the sample to a lab.

A health care professional collecting blood from a patient.
Your doctor may order one or more blood tests to diagnose hepatitis D.

Additional tests

If you have chronic hepatitis D and hepatitis B, you could have liver damage. Your doctor may recommend tests to find out whether you have liver damage or how much liver damage you have—or to rule out other causes of liver disease. These tests may include

  • blood tests.
  • elastography, a special ultrasound that measures the stiffness of your liver.
  • a liver biopsy, in which a doctor uses a needle to take a small piece of tissue from your liver. A pathologist will examine the tissue under a microscope to look for signs of damage or disease.

Doctors typically use liver biopsy only if other tests don’t provide enough information about the liver damage or disease. Talk with your doctor about which tests are best for you.

How do doctors treat hepatitis D?

Doctors may treat chronic hepatitis D with medicines called interferons, such as peginterferon alfa-2a (Pegasys). Researchers are studying new treatments for hepatitis D. In addition, medicines for hepatitis B may be needed. These are usually medicines taken once daily by mouth.

How do doctors treat the complications of hepatitis D?

If chronic hepatitis D leads to cirrhosis, you should see a doctor who specializes in liver diseases. Doctors can treat health problems related to cirrhosis with medicines, surgery, and other medical procedures. If you have cirrhosis, you have a greater chance of developing liver cancer. Your doctor may order an ultrasound or other type of imaging test to check for liver cancer every 6 months.

If acute hepatitis D leads to acute liver failure, or if chronic hepatitis D leads to liver failure or liver cancer, you may need a liver transplant.

How can I protect myself from hepatitis D infection?

If you do not have hepatitis B, you can prevent hepatitis D infection by taking steps to prevent hepatitis B infection, such as getting the hepatitis B vaccine. If you do not get hepatitis B, you cannot get hepatitis D.

If you already have hepatitis B, you can take steps to prevent hepatitis D infection by

  • not sharing drug needles or other drug materials
  • wearing gloves if you have to touch another person’s blood or open sores
  • not sharing personal items such as toothbrushes, razors, or nail clippers

How can I prevent spreading hepatitis D to others?

If you have hepatitis D, follow the steps above to avoid spreading the infection. Your sex partners should get a hepatitis B test and, if they aren’t infected, get the hepatitis B vaccine. Preventing hepatitis B will also prevent hepatitis D.

You can protect others from getting infected by telling your doctor, dentist, and other health care professionals that you have hepatitis D. Don’t donate blood or blood products, semen, organs, or tissue.

Is a hepatitis D vaccine available?

No vaccine for hepatitis D is currently available. The hepatitis B vaccine can prevent hepatitis D by preventing hepatitis B.

Eating, diet, and nutrition for hepatitis D

If you have hepatitis D, you should eat a balanced, healthy diet. Talk with your doctor about healthy eating. You should also avoid alcohol because it can cause more liver damage.

References

May 2017
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This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank:
Raymond Chung, M.D., Massachusetts General Hospital