Hepatitis D is a viral liver infection caused by the hepatitis D virus. What is special is that hepatitis D can only occur if the affected person also has a hepatitis B virus infection. How is the disease transmitted, what are the symptoms and how is it treated?
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Quick overview: Frequently asked questions and answers
What is hepatitis D? It is an inflammation of the liver caused by the hepatitis D virus (HDV) that only occurs in conjunction with a hepatitis B infection.
How is hepatitis D transmitted? Hepatitis D is transmitted primarily through blood-to-blood contact, often through infected needles.
What are the symptoms of a hepatitis D infection? Symptoms include fatigue, jaundice, nausea and abdominal pain, similar to other forms of hepatitis.
At a glance:
Liver inflammation: The right diet for hepatitis
What is hepatitis D?
Hepatitis D (Delta, HDV) is one of the liver inflammations caused by viruses, which are also known as viral hepatitis. Various forms of hepatitis can be distinguished.
One form is hepatitis D, which is caused by the hepatitis D virus. However, hepatitis D can only occur if there is also an infection with the hepatitis B virus.
HDV is a defective RNA virus (virusoid) that does not have its own envelope. It therefore requires certain envelope proteins from HBV in order to reproduce.
Hepatitis D is considered to be the most dangerous hepatitis virus currently known. The infectious disease can quickly cause liver cirrhosis or liver cancer.
Occurrence and frequency
Hepatitis D is a virus that can occur anywhere in the world, but it is particularly prevalent in areas such as
- north africa,
- the Middle East,
- South America or
- the Mediterranean region.
Approximately 250 million people worldwide are chronically infected with HBV. Of these, 15 to 25 million are also infected with HDV.
However, hepatitis D is very rare in Germany.
Transmission of hepatitis D
There are two ways in which hepatitis D can be transmitted:
-
Superinfection: A person who already has the hepatitis B virus also becomes infected with hepatitis D.
-
Simultaneous infection: The term describes a simultaneous infection with both viruses. It is also referred to as a co-infection.
The hepatitis D virus can enter the human body through infected blood. Drug addicts who share syringes and injection equipment with infected people are therefore particularly at risk.
Infection via blood transfusions or blood products is also theoretically possible, although blood donations are now strictly tested for various germs.
It is rare for the hepatitis D virus to be transmitted from one person to another through sexual contact. It is also rare for the child to become infected by the mother in the last weeks of pregnancy and in the first days of life (perinatally).
Incubation period of hepatitis D
Between two weeks and eight months can pass between infection with the hepatitis D virus and the appearance of the first symptoms (incubation period). The incubation period is usually shorter in the case of a superinfection than in the case of a simultaneous infection with hepatitis B and D.
Symptoms and course: This is how hepatitis D manifests itself
Sudden onset, acute hepatitis D often begins with
- a general feeling of illness,
- Fatigue,
- Nausea and/or
- Loss of appetite.
In addition, pressure pain can develop in the upper right abdomen, where the liver is located. Later, jaundice (icterus) may develop, with yellowing of the skin, mucous membranes and eyes, as well as itching. Enlargement of the liver is also possible.
Severe course in case of superinfection
In the case of a superinfection, severe disease progression is more common than in the case of simultaneous infection with both viruses. The infection can start suddenly, progress quickly and severely and lead to life-threatening liver failure.
About 70 to 90 percent of patients with superinfection develop chronic hepatitis D over time. The chronic viral infection is apparently associated with a higher risk of connective tissue remodeling of the liver (liver cirrhosis) than chronic hepatitis B.
Diagnosis: How is hepatitis D diagnosed?
Hepatitis D is suspected if
- acute hepatitis B has a severe course
- Chronic hepatitis B suddenly worsens
To detect HPV, the affected person’s blood is tested for antibodies (immunoglobulins) that are produced by the immune system and are directed against the hepatitis D virus. The virus or its genetic material can also be detected through special tests.
Furthermore, an examination of liver tissue samples (liver biopsies) may be necessary to check whether the B and D viruses are present in the liver cells.
Treatment for hepatitis D
As with other hepatitis diseases, it is recommended that patients with hepatitis D initially remain in bed. Patients should also avoid alcohol.
The doctor will check whether medications you take regularly are absolutely necessary and, if necessary, stop them. This usually only applies to medications that can damage the liver.
To treat hepatitis D, the use of so-called interferons is recommended, which are intended to counteract the inflammation. However, their effectiveness is limited. About 20 to 30 percent of patients still have a detectable amount of virus in their blood six months after treatment.
New drug for the treatment of HPV
Researchers at the German Center for Infection Research (DZIF) and the University of Heidelberg developed the first drug to treat hepatitis D. The active ingredient bulevirtide will be fully approved in 2023.
The drug prevents HDV and HBV from entering the cells and can be administered together with interferon. In studies, this therapy was able to significantly reduce the viral load after 48 weeks. In half of the cases, the HDV RNA fell below the detection limit.
forecast
Acute hepatitis D heals in 90 percent of cases of simultaneous infection. However, in the majority of cases of superinfection, it lasts up to six months or longer (chronic course).
If the liver is so affected by the inflammation that it can no longer perform its function, a liver transplant may be necessary.
Hepatitis D: Prevention and vaccination
There is no vaccination against hepatitis D directly. However, the hepatitis B vaccination has been recommended for years as a standard vaccination for infants and unvaccinated children and adolescents under 18 years of age. Certain professional groups, such as medical personnel, also receive this vaccination.
Using condoms during sexual intercourse can protect against infection with hepatitis D. If there is contact with infected blood, for example through needlestick injuries sustained by medical personnel when taking blood from infected people, so-called post-exposure vaccinations (i.e. vaccinations carried out after infectious contact) can be useful. In these vaccinations, those affected receive an active and a passive vaccination against the hepatitis B virus at the same time.
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Source: www.lifeline.de
