Definition

Hepatitis D is a viral infection caused by the hepatitis D virus (previously called the Delta agent). It causes symptoms only in people who also have hepatitis B infection.

Alternative Names

Delta agent

Causes

Hepatitis D virus (HDV) is found only in people who carry the hepatitis B virus. HDV may make liver disease worse in people who have either recent (acute) or long-term (chronic) hepatitis B. It can even cause symptoms in people who carry hepatitis B virus but who never had symptoms.

Hepatitis D infects about 15 million people worldwide. It occurs in a small number of people who carry hepatitis B.

Risk factors include:

• Being infected while pregnant (the mother can pass the virus to the baby)
• Carrying the hepatitis B virus
• Men having sexual intercourse with other men
• Receiving many blood transfusions
• Using intravenous (IV) or injection drugs

Symptoms

Hepatitis D may make the symptoms of hepatitis B worse.

Symptoms may include:

• Abdominal pain
• Dark-colored urine
• Fatigue
• Jaundice
• Joint pain
• Loss of appetite
• Nausea
• Vomiting

Exams and Tests

You may need the following tests:

• Anti-hepatitis D antibody
• Liver biopsy
• Liver enzymes (blood test)

Treatment

Many of the medicines used to treat hepatitis B are not helpful for treating hepatitis D.

You may receive a medicine called alpha interferon for up to 12 months if you have a long-term HDV infection. A liver transplant for end-stage chronic hepatitis B may be effective.

Outlook (Prognosis)

People with an acute HDV infection most often get better over 2 to 3 weeks. Liver enzyme levels return to normal within 16 weeks.

About 1 in 10 of those who are infected may develop long-term (chronic) liver inflammation (hepatitis).

Possible Complications

Complications may include:

• Chronic active hepatitis
• Acute liver failure

When to Contact a Medical Professional

Contact your health care provider if you have symptoms of hepatitis B.

Prevention

Steps to prevent the condition include:

• Detect and treat hepatitis B infection as soon as possible to help prevent hepatitis D.
• Avoid intravenous (IV) drug abuse. If you use IV drugs, avoid sharing needles.
• Get vaccinated against hepatitis B.

Adults who are at high risk for hepatitis B infection and all children should get this vaccine. If you do not get Hepatitis B, you cannot get Hepatitis D.

References

Alves VAF. Acute viral hepatitis. In: Saxena R, ed. Practical Hepatic Pathology: A Diagnostic Approach. 2nd ed. Philadelphia, PA: Elsevier; 2018:chap 13.

Ghany MG. Hepatitis D. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 81.

Murray PR, Rosenthal KS, Pfaller MA. Hepatitis viruses. In: Murray PR, Rosenthal KS, Pfaller MA, eds. Medical Microbiology. 9th ed. Philadelphia, PA: Elsevier; 2021:chap 55.

Thio CL, Hawkins C. Hepatitis delta virus. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 146.