Hepatitis D, also known as “delta hepatitis” affects only those who have been exposed to the hepatitis B virus — if you contract both, the one-two punch can cause serious liver problems.
The hepatitis D virus depends on another virus, namely the one that causes hepatitis B, to reproduce itself. This means hepatitis D can only infect people who are already infected with the hepatitis B virus, or who are exposed to hepatitis B at the same time they’re exposed to hepatitis D. (1)
When you are infected with hepatitis B and D at the same time, it’s called coinfection.
If you already have chronic hepatitis B and are then exposed to the hepatitis D virus, it’s called a superinfection. In either case, this double whammy can lead to serious problems. (1)
Hepatitis D can cause significant liver damage and even death, so prevention of this dual infection is crucial. (1)
Hepatitis D can cause an acute or chronic infection, or both. (2) The acute infection lasts a short time, and the chronic infection lasts longer than six months. (3)
Signs and Symptoms of Hepatitis D
People who have acute hepatitis D usually have symptoms, which can include the following: (2)
- Fatigue and lethargy
- Loss of appetite
- Jaundice, which causes a yellowish tint to the whites of the eyes and skin
- Discolored stools and urine
- Pain over the liver, in the upper part of the abdomen
In contrast, the majority of people with chronic hepatitis D will have few symptoms until complications develop. This could be several years after the initial infection. These symptoms can include the following: (2)
- Weakness and fatigue
- Weight loss
- Swelling of the ankles and abdomen
- Itchy skin
How Is Hepatitis D Diagnosed?
Doctors may suspect a person has hepatitis D when the symptoms of acute hepatitis B are unusually severe, chronic hepatitis B gets worse much faster than usual, or when chronic hepatitis B suddenly gets much worse, which would indicate a superinfection. (3)
If hepatitis D is suspected, the doctor will take a medical history to understand factors that may have led to the infection. A physical exam will look for signs of liver damage, which could include jaundice, swelling in the feet or ankles, and swelling or tenderness in the abdomen. (2)
If it’s suspected that a person may have hepatitis D, a blood test that confirms the presence of the antibodies that are produced in response to the infection is required to confirm the diagnosis. (3)
There may be additional tests to determine if there is liver damage as a result of hepatitis B and hepatitis D. The tests can include the following: (2)
- An elastography, a special ultrasound that can measure the stiffness of the liver
- A liver biopsy, in which a long needle is used to take a small piece of tissue that will be examined under a microscope to look for signs of disease or damage (2)
- A blood test to measure liver enzyme levels, elevated levels of which often indicate inflammation or damage to the liver cells
Prognosis of Hepatitis D
Your health outlook depends on whether you were coinfected or superinfected with hepatitis D; the prognosis is better for people who were coinfected.
The vast majority of coinfected people experience only the acute phase of the disease; most of these people will get better over two to three weeks. Liver enzyme levels typically return to normal within four months. (4)
About 10 percent of people infected with hepatitis D develop a chronic liver infection. (4)
Chronic hepatitis D leads to cirrhosis, or scarring of the liver, in about 70 to 80 percent of cases. (5,6) Once a person has cirrhosis, the disease may remain stable for as long as 10 years, although a high percentage of people with chronic hepatitis D and cirrhosis eventually die of acute liver failure or liver cancer unless they get a liver transplant.
The overall mortality rate of hepatitis D is unclear, with estimates placing it between 2 and 20 percent. As with most forms of hepatitis, prevention is the best strategy. (7)
Treatment and Medication Options for Hepatitis D
Medications are not effective against acute hepatitis D, but fortunately, the acute infection tends to subside on its own.
As for chronic hepatitis D, appropriate treatment depends on the phase of the disease and how severe the infection is.
If a person’s liver is severely damaged, a liver transplant may become necessary.
While treatment options for hepatitis D are limited, new medications are being studied.
Doctors may prescribe a drug called interferon alfa or, alternatively, one called pegylated interferon alpha, for chronic hepatitis D.
Interferons are naturally occurring proteins that are made and secreted by cells of the immune system. Those used to treat disease are human interferons manufactured using recombinant DNA technology.
Given in high doses for one year, interferon can put chronic hepatitis D into remission, but usually does not completely rid the body of infection. (8)
A few new antiviral agents that target various stages of chronic hepatitis D are showing promising results. Although not approved for use in the United States, a drug known as Hepcludex was approved by the European Commission for the treatment of hepatitis D. (9)
Alternative and Complementary Therapies
No alternative or complementary therapies have been shown to improve or cure hepatitis D.
People who have hepatitis D should follow a healthy diet and avoid alcohol, because it can cause more liver damage. (2)
Prevention of Hepatitis D
Although there is no vaccine for hepatitis D, an effective vaccine does exist for hepatitis B. Since hepatitis D cannot survive without hepatitis B, a vaccination against hepatitis B will protect you from both strains.
It’s important to note that the hepatitis B vaccine is only effective at preventing coinfection, not superinfection. (2)
If you already have hepatitis B, other prevention strategies will help you avoid hepatitis D.
You can prevent hepatitis D and other bloodborne illnesses like hepatitis C and HIV by avoiding these high-risk behaviors: (2)
- Sharing intravenous drug paraphernalia
- Having unprotected sex
- Sharing personal-care items with a person who has hepatitis D, especially those items that may have trace amounts of blood on them, such as razors or toothbrushes.
If you have hepatitis D you shouldn’t donate blood or blood products, sperm, organs, or tissue. (2)
Research and Statistics: How Many People Have Hepatitis D?
Hepatitis D was first identified as a distinct form of hepatitis in 1977. (13) A systematic review and meta-analysis published on April 23, 2020, in the Journal of Hepatology estimated its worldwide prevalence at 12 million people. (14)
Hepatitis D is rare in the United States, and most cases occur among people who migrate or travel to the United States from countries that have a higher rate of HDV.
Hepatitis D is not a nationally notifiable condition, so the actual number of people who have it is unknown. (15)
Study results published in Clinical Infectious Diseases found that approximately 0.11 percent of the more than 21,000 subjects had antibodies, which would indicate they had hepatitis D infection. That would correspond to approximately 357,000 people in the United States with a past or ongoing HDV infection. (16)
The researchers found that the prevalence of hepatitis D is highest in Asian Americans and people born outside the United States. (16)
The condition most closely related to hepatitis D is hepatitis B, a liver infection caused by the hepatitis B virus (HBV) and spread from person to person through blood, semen, or other body fluids.
There is a vaccine available to prevent hepatitis B. For some people, HBV is a short-term illness and for others it can be a long-term, chronic infection that can have life-threatening complications such as cirrhosis or liver cancer. (21)
A person must be infected with HBV to contract hepatitis D.
Resources We Love
These organizations can provide more information about hepatitis D, including its transmission, symptoms, diagnosis, treatment, and complications.
Centers for Disease Control and Prevention (CDC)
The government agency provides information for both healthcare providers and the public, including a list of questions and answers about hepatitis D.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
This government organization provides research and funding for diseases that are among the most chronic, costly, and consequential for U.S. patients and their families. The website offers current information about hepatitis D.
World Health Organization (WHO)
This organization focuses on improving health around the world. They provide guidance, resources, and recommendations about diseases, including hepatitis D.
Additional reporting by Becky Upham.
Editorial Sources and Fact-Checking
- Hepatitis D. Viral Hepatitis. Centers for Disease Control and Prevention. June 22, 2020.
- Hepatitis D. National Institute of Diabetes and Digestive and Kidney Diseases. May 2017.
- Hepatitis D. Merck Manual: Consumer Version. October 2019.
- Delta Agent (Hepatitis D). Mount Sinai.
- Botelho-Souza L, et al. Hepatitis Delta: Virological and Clinical Aspects. Virology Journal. September 13, 2017.
- Farci P, Niro GA. Current and Future Management of Chronic Hepatitis D. Gastroenterology & Hepatology. June 2018.
- Hepatitis D. Fact Sheet. Pan American Health Organization.
- Hepatitis D. Merck Manual Professional Version. October 2019.
- Hepcludex. European Medicines Agency. July 10, 2020.
- Cirrhosis. Mayo Clinic. December 7, 2018.
- The Progression of Liver Disease. American Liver Foundation.
- Hepatocellular Carcinoma. Liver Cancer. Mayo Clinic. May 4, 2019.
- Rizzetto M, Canese MG, Aricò S, et al. Immunofluorescence Detection of New Antigen-Antibody System (Delta/Anti-Delta) Associated to Hepatitis B Virus in Liver and in Serum of HBsAg Carriers. Gut. December 1977.
- Stockdale AJ, Kreuels B, Henrion MYR, et al. The Global Prevalence of Hepatitis D Virus Infection: Systematic Review and Meta-Analysis. Journal of Hepatology. April 23, 2020.
- Hepatitis D Questions and Answers for Health Professionals. Viral Hepatitis. Centers for Disease Control and Prevention. March 9, 2020.
- Patel EU, et al. Prevalence of Hepatitis B and Hepatitis D Virus Infections in the United States, 2011–2016. Clinical Infectious Diseases. January 30, 2019.
- Viral Hepatitis Surveillance Report 2018 — Hepatitis B. Centers for Disease Control and Prevention. July 27, 2020.
- Hepatitis and African Americans. U.S. Department of Health and Human Services, Office of Minority Health. May 23, 2018.
- Hu DJ, Xing J, Tohme RA, et al. Hepatitis B Testing and Access to Care Among Racial and Ethnic Minorities in Selected Communities Across the United States, 2009–2010. Hepatology. August 6, 2013.
- Hepatitis and Hispanic Americans. U.S. Department of Health and Human Services, Office of Minority Health. May 24, 2018.
- Hepatitis B. Viral Hepatitis. Centers for Disease Control and Prevention. June 22, 2020.