Hepatitis D is also called as hepatitis delta virus (HDV). It is a unique virus which is dependent on another virus (hepatitis B virus) for its presence and also its replication.
Delta virus is a small (36 nm), circular, single stranded RNA virus coated with HBsAg.
When infection with hepatitis B and delta virus occurs simultaneously in a healthy subject (co-infection), acute viral hepatitis occurs; only 2% suffer from chronic viral hepatitis. If delta virus infection occurs in a chronic carrier of HBV (super-added infection), then fulminant hepatic failure occurs in 5% of cases and chronic viral hepatitis occurs in 75% of patients.
There are about 20 million carriers of HDV in the world, of who 4-5 million are in India.
Hepatitis D Transmission
- HDV is transmitted parenterally to those receiving blood transfusion and intravenous drug abusers.
- It can also be caused by contaminated, needles and syringes; razors, tattooing.
- Intra-familial, sexual and vertical transmission is rare with hepatitis delta virus infection.
- Incubation period is 20-50 days.
Clinical Features Of Hepatitis D
- Common features of anorexia, nausea, fatigue are present.
- Delta virus infection should be suspected when a double AST and ALT peak is observed in a patient with acute viral B hepatitis or when an acute viral hepatitis is seen in a chronic carrier of HBsAg.
- Hepato-cellular carcinoma is uncommon as patients do not survive too long with super infection.
Investigations
- IgM anti-delta indicates acute delta virus hepatitis; together with HBsAg and high titers of IgM anti-HBsAg indicates a co-infection.
- In patients with super infection, IgM anti-delta and IgG anti-delta are positive.
Prevention And Treatment Of Hepatitis Delta Virus
Control of hepatitis B virus infection will usually control hepatitis D virus infection.
- Therefore avoid blood spilling during collection, storage and transport.
- Avoid all unnecessary infusions and injections.
- Always use disposable needles and syringes.
- Autologous blood transfusions should be encouraged for elective surgeries.
Hepatitis D Treatment
- Response to interferon in chronic hepatitis due to HDV is usually poor.
- The response to larger doses and longer duration of interferon therapy needs further evaluation.
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