Hepatitis D Virus (HDV) Infection

Background

• HDV is a defective RNA virus that requires the hepatitis B virus (HBV) for assembly, replication, and transmission.
• HDV can only infect humans concurrently with HBV or through superinfection in persons with established chronic HBV.
• An estimated 10-20 million persons are coinfected with HBV and HDV worldwide.
• Risk factors for acquiring HDV are the same as for HBV, such as IV drug usage and sexual contact with a HDV carrier.
• Clinical manifestations range from self-limiting acute hepatitis to severe fulminant hepatitis or rapidly progressive chronic hepatitis leading to cirrhosis in the majority of patients.

Evaluation

• Consider the diagnosis of HDV in patients with acute hepatitis or hepatitis B exacerbation.
• Distinguishing acute coinfection from superinfection is important as the prognosis differs.
• The diagnosis of acute HDV/hepatitis B virus (HBV) coinfection with HBV can be confirmed by detection of HDV immunoglobulin (Ig) M antibodies and high titers of HBV core antigen-specific IgM antibodies.
• Diagnosis of HDV superinfection in patients with chronic hepatitis B can be confirmed by presence of HDV antibodies and absence of HBV core antigen-specific IgM antibodies.

Management

• Treatment options are limited.
  • Bulevirtide has been authorized by the European Commission for treatment of chronic HDV infection in adults with compensated liver disease.
  • Standard and pegylated interferons have both been used.
• Orthotopic liver transplantation is the only treatment available for fulminant hepatitis or end-stage HDV-related liver disease.
• HBV vaccination is important to prevent the transmission of both hepatitis B and D viruses.