Hepatitis D – What Causes It?

Hepatitis D is a virus that results in the liver becoming inflamed and suffering harm. When tissue in the body is hurt or infected, it can lead to swelling, which we refer to as inflammation. Inflammation can damage organs.

Normal cells in the body are infiltrated by viruses coming from the NIH external link. Numerous viruses can lead to diseases that can be transmitted from one individual to another.

You must already have a hepatitis B virus infection to be vulnerable to the hepatitis D virus, which makes it an unusual virus. In this way, hepatitis D is a double infection. Getting the Hepatitis B vaccine is the best way to guard against contracting Hepatitis D.

Hepatitis D is passed from one person to another in a similar manner to hepatitis B, through exposure to blood or other bodily fluids from an infected individual.

Hepatitis D can trigger either a speedy or prolonged sickness, or both scenarios.

Acute hepatitis D

Acute hepatitis D is a short-term infection. The indicators of acute hepatitis D are comparable with the warning signs of any strain of hepatitis and tend to be more intense. Occasionally, the body can combat the infection and the virus disappears.

Chronic hepatitis D

Chronic hepatitis D is a long-lasting infection. Chronic hepatitis D arises when the body is unable to effectively combat the virus, and the virus remains persistent. Individuals with chronic hepatitis B and D often experience difficulties more swiftly and frequently than those with just chronic hepatitis B.20

How do hepatitis D and hepatitis B infections occur together?

A person may be afflicted with both hepatitis B and hepatitis D at the same time, whether it be as a combined infection or an added infection. You can only contract hepatitis D if you already have hepatitis B.

Coinfection

Having both hepatitis B and hepatitis D at the same time is referred to as a coinfection. Generally, coinfections result in brief, or fleeting, hepatitis D and B ailments. Coinfections may cause severe acute hepatitis.

Most of the time, people are capable of overcoming and defeating acute hepatitis B and D infections so that the viruses are no longer present. In approximately 5 percent of individuals who have both a coinfection, the infections stay and do not disappear.21

Superinfection

If you have an existing chronic hepatitis B infection and then get infected with hepatitis D, it is referred to as a superinfection. You could experience extreme acute hepatitis symptoms when you contract a super infection.

Roughly nine out of ten individuals with a superinfection are not capable of warding off the hepatitis D virus, resulting in the development of chronic hepatitis D. This leads to a situation in which these people then have both chronic hepatitis B and chronic hepatitis D.

How common is hepatitis D?

Hepatitis D is not common in the United States. Hepatitis D is a condition found in multiple countries and geographical areas around the world including Eastern and Southern Europe, the Mediterranean, the Middle East, parts of Asia including Mongolia, Central Africa, and the Amazon Basin in South America.

Who is more likely to have hepatitis D?

Hepatitis D only afflicts individuals already infected with hepatitis B. The probability of someone having both hepatitis B and hepatitis D is higher than those who only have hepatitis B.

• are injection-drug users
• have lived with or had sex with someone who has hepatitis D
• are from an area of the world where hepatitis D is more common

What are the complications of acute hepatitis D?

Acute hepatitis D is occasionally the cause of an abrupt liver collapse, which is called acute liver failure. Even though it is not very common, acute liver failure is more likely to be a result of hepatitis D and B infections, as compared to only having a hepatitis B infection.24

What are the complications of chronic hepatitis D?

Persistent hepatitis D can cause scarring of the liver (cirrhosis), liver dysfunction, and liver cancer. Individuals with both chronic hepatitis B and D are more liable to experience related issues than those with just chronic hepatitis B. Prompt diagnosis and treatment of chronic hepatitis B and D can aid in reducing the risk of developing severe health issues.

Cirrhosis

A gradual deterioration of the liver occurs in cirrhosis, impairing its ability to perform its regular functions. Tissue that has been damaged by scarring takes the place of pre-existing healthy liver tissue, obstructing a portion of the blood that passes through the liver. At the beginning of cirrhosis, the liver stays operational. As cirrhosis gets worse, the liver begins to fail.

Liver failure

Eventually leading to end-stage liver disease, liver failure’s advancement can take a few months or several years. In the final stage of liver disease, the organ is no longer able to carry out necessary tasks or repair damaged cells.

Liver cancer

People with both chronic hepatitis B and D are more prone to developing liver cancer, according to the National Institutes of Health. A doctor might suggest having blood tests done, in addition to undergoing an ultrasound or a different kind of imaging test, in order to look for evidence of liver cancer. Discovering cancer during its early stages increases the likelihood of being able to treat the malady.

What are the symptoms of hepatitis D?

The majority of individuals who suffer from acute hepatitis D display symptoms, such as:

• 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 comparison, those with chronic hepatitis D will likely have few, if any, symptoms at first, but those could turn into complications 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. Hepatitis D is transmitted through contact with the contaminated blood or bodily secretions of an infected individual. 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

It is uncommon for a mother to transmit the hepatitis D virus to her baby during the birthing process.

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

Diagnosis

Identifying the indications of infection is seemingly the most difficult aspect of diagnosing hepatitis D. It is not often seen in the US, so it is possible to miss out on diagnosing hepatitis D in a patient, especially if there is a dual infection of HBV and HDV.

People who have been previously identified with HBV may notice a sudden deterioration in their symptoms due to HDV superinfection.

There are a variety of explanations as to why hepatitis signs resurface, yet several indicators point to HDV’s participation (i.e. touring an area with a high concentration of the virus or injecting illicit drugs).

HDV Screening Recommendations

Screening for Hepatitis Delta Virus (HDV) is advised by the American Association for the Study of Liver Disease (AASLD) for those who are at higher risk of this virus, such as intravenous drug users, individuals with HIV, men who engage in sexual activities with other men, and those who have recently arrived from areas where this virus is more prevalent.

If there is a possibility of an HDV infection, it can be identified by conducting a few blood examinations.

Total Antibody Test

A HDV total antibody test is employed to identify the assorted antibodies (immunoglobulins) that the body creates amid varying degrees of contamination. This means that the body produces IgM at the beginning of the infection and IgG when there is a decline in the amount of IgM.

The test results can be used to not only verify whether or not an infection is present, but to also discern the type of infection based on which antibodies are high. The IgM/IgG pattern can be used to figure out if the infection is new or has been present for a lengthy period of time, or if there is an additional infection or an infection that has taken over an already existing one.

PCR Qualitative Tests

If a total antibody test indicates positive results, then PCR (Polymerase Chain Reaction) qualitative tests are usually done. Rather than assessing the presence of antibodies to determine infection, this test uses PCR technology to identify viral RNA, a direct measure of the virus itself.

The Polymerase Chain Reaction (PCR) test can be used to verify whether a diagnosis is correct and determine if the infection is still present. This type of information can help guide the best treatment plan.

Other Tests and Procedures

Once a person is diagnosed with hepatitis D, tests are regularly carried out to track the development of the sickness and ascertain how they are responding to the treatment.

• Liver function tests (LFTs) : A panel of blood tests that indicates the status of the liver based on enzymes produced in response to liver injury
• Platelet count : A blood test that is used to detect changes in blood consistent with portal hypertension (a complication of cirrhosis)
• Fibroscan : A specialized form of ultrasound that can measure and monitor liver scarring (fibrosis)
• Fibrosis-4 (FIB-4) Index : A scoring system based on a person’s age and lab results that can estimate the degree of liver impairment and the stage of fibrosis
• HDV viral load : A blood test (also known as the quantitative HDV PCR) that measures the amount of virus in a sample of blood

Due to the possibility of using non-invasive assessments, a liver biopsy is not as often utilized for determining the extent of a disease. If the assessment is uncertain or if there is an accompanying condition such as nonalcoholic fatty liver disease (NAFLD) or alcohol-related liver disease (AALD) present, it may be employed.

Treatment

No medications exist to treat hepatitis D specifically, unlike with hepatitis B.

The CDC’s 2021 update to the guidelines for treating STIs state that there is presently no specific cure for those who are experiencing acute hepatitis B.

People with long-term hepatitis B should visit an expert who has experience managing these types of infections and take medication to assist in blocking further development of their liver disease and drive them towards recovery.

Medicines that are regularly employed to treat hepatitis B virus (HBV) such as Viread (tenofovir) and Baraclude (entecavir) are not very successful in treating hepatitis D virus (HDV). They might be tried out in a joint treatment program as an experiment.

Pegylated Interferon-Alpha

Interferon-alpha which has been treated by a process called pegylation and is used for the therapeutic purposes of hepatitis B and C since 2000s is mainly given as the primary medical treatment for hepatitis D.

The treatment consists of a weekly subcutaneous injection over the course of at least twelve months to lower the level of HDV in the bloodstream. Injections can be administered in the home either with a regular syringe plus medication container or a pen-style autoinjector.

Research has revealed that administering pegylated IFN-a can assist 25 percent of individuals struggling with chronic hepatitis D to acquire a permanent undetectable level of the virus in a period of six months. Nonetheless, the amount of virus in the body will usually come back up when the therapy ends.

The side effects of taking pegylated IFN-a over a long period of time are quite serious. Common side effects include:

• Cough
• Sore throat
• Fevers and chills
• Flushing
• Loss of appetite
• Changes in taste
• Nausea
• Depression
• Irritability
• Lethargy
• Trouble sleeping
• Unusual bruising or bleeding
• Ulcers, sores, or plaques in the mouth
• Diarrhea
• Constipation
• Difficulty urinating or painful urination
• Black tarry stools

Prolonged utilization of pegylated IFN-a can likewise raise the odds of developing diabetes, thyroid abnormality, renal disability, seizures, and some autoimmune ailments.

Other Treatments

Some trial medications have demonstrated potential as a remedy for HDV. Among some of the leading candidates are:

• Hepcludex (bulevirtide) is an oral drug that prevents HDV from entering liver cells. Early studies have shown that Hepcludex is tolerable and can reduce the viral load to undetectable levels in some people. Hepcludex was approved for use by the European Union in 2020.
• Zokinvy (lonafarnib) is an oral drug that prevents HBV replication by blocking the enzymes that are needed to assemble new viruses. When used in combination with pegylated IFN-a and an antiviral called ritonavir, Zokinvy can reduce the HDV viral load and normalize liver enzymes in some people.

Liver Transplant

The most effective method of treating those who suffer from decompensated cirrhosis is a liver transplant.

After the transplant, a mix of IV anti-HBV antibodies and oral anti-viral medications may stop the reappearance of hepatitis B. Without HBV to facilitate replication, HDV cannot recur.

According to a 2019 study published in Transplant Proceedings, just 14% of those who underwent a liver transplant concerning Hepatitis Delta Virus had a relapse.