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Hepatitis D is an infection and inflammation of the liver caused by the hepatitis D virus. It is one of several types of hepatitis. The hepatitis D virus needs the hepatitis B virus to be present to cause an infection. These 2 viruses may be acquired at the same time. Also, a person may already have a chronic hepatitis B infection, then catch hepatitis D.
What is going on in the body?
The liver is an important organ located in the upper right quadrant of the abdomen. It is responsible for:
Infection of the liver by a virus can cause hepatitis, which is a term that means inflammation of the liver. Hepatitis can interfere with normal liver functions. Hepatitis that comes on quickly and is severe is called acute hepatitis. Hepatitis that develops slowly and lasts a long time is called chronic hepatitis.
- filtering the blood
- making bile, a substance that aids in digestion and helps rid the body of harmful substances
- processing fats and sugars, helping the body store energy for later use
- making important proteins, such as those involved in blood clotting
- metabolising many medications, such as barbiturates, sedatives, and amphetamines
- storing vitamins A, B12, D, and several of the B-complex vitamins. The liver also stores iron and copper.
Hepatitis D can damage the liver:
Someone who does not have hepatitis B or who is immune to the B virus is protected from the hepatitis D virus.
- through direct liver cell damage
- through inflammation, which is caused by the immune system attacking the virus
What are the signs and symptoms of the infection?
In some cases, hepatitis B may cause mild or moderate symptoms, including: Hepatitis D virus infection is often severe if it occurs in someone who already has chronic hepatitis B. This acute fulminant form of hepatitis involves severe liver cell destruction and loss of liver function. It can be fatal. Symptoms include:
Chronic liver disease, which may occur with hepatitis D, often has minimal symptoms. At times there may be mild flare-ups with jaundice, nausea, fatigue, and weight loss.
- an enlarged, painful liver
- enlarged spleen
- severe jaundice
- susceptibility to bleeding
- encephalopathy, a disorder in the functioning of the brain
- aplastic anaemia in rare cases. Aplastic anaemia is a condition in which the bone marrow cannot make enough red and white blood cells.
What are the causes and risks of the infection?
Hepatitis D and hepatitis B are spread through exposure to infected blood and by sexual intercourse. People at risk include those who:
Each year, fewer cases are reported due to use of the hepatitis B vaccine. Those who receive the hepatitis B vaccine do not usually catch hepatitis D, even if exposed to it.
- puncture themselves with contaminated needles and syringes, such as intravenous drug abusers or healthcare workers
- are stuck with contaminated needles during tattooing, acupuncture, or body piercing
- are sexually promiscuous, whether homosexual or heterosexual
- have had an organ transplant or blood transfusion, though blood is now screened for hepatitis B to prevent this form of transmission
What can be done to prevent the infection?
Right now, there is no vaccine for hepatitis D. The best way to prevent the D virus is to prevent hepatitis B. This can be done by getting the hepatitis B vaccine, avoiding unsterile needles, and following safer sex guidelines.
How is the infection diagnosed?
The doctor may suspect hepatitis D after doing a physical examination and checking liver function tests. Another blood test, often drawn at the same time as the liver function tests, can confirm that hepatitis D is the cause of the symptoms.
Chronic hepatitis can be diagnosed with a liver biopsy. Liver biopsy specimens can be graded in terms of severity. Liver biopsies may have to be done repeatedly to detect progression of the disease or response to therapy.
What are the long-term effects of the infection?
Rarely, chronic liver disease and cirrhosis can occur. Cirrhosis is a serious disease that causes scarring of the liver. Severe hepatitis and cirrhosis may require a liver transplant and can result in death.
What are the risks to others?
A person with the hepatitis D virus can usually transmit both hepatitis B and hepatitis D. The viruses have been found in blood, saliva, semen, and vaginal secretions of infected individuals. They can be spread through sexual contact with an infected person, passed on to a newborn from an infected mother during childbirth, or transmitted by contact with infected blood or bodily fluids.
What are the treatments for the infection?
Treatment of hepatitis D includes: For sudden, severe hepatitis D, treatment takes place in the hospital. A person may require antibiotics, vitamin K injections, blood and plasma transfusions, and fluids.
For chronic hepatitis D, treatment includes the antiviral drug alpha interferon, which can help if cirrhosis has not developed. It is more effective in the early stage of the disease.
Some people with severe hepatitis or end-stage liver disease may need a liver transplant. Hepatitis can recur in the transplanted liver, but it is rare.
What are the side effects of the treatments?
Side effects will depend on the treatments used. Side effects of interferon include a flu-like illness, with fever and body aches.
A liver transplant can cause many problems, including failure or rejection of the new liver. After a liver transplant, a person will need to take powerful antirejection medications for the rest of his or her life. Side effects of these medications increase the person's risk for infections, certain cancers, and other problems.
What happens after treatment for the infection?
A person with hepatitis D will be monitored for side effects and benefits during and after interferon treatment. Alpha interferon treatment might be repeated if the disease flares up again.
How is the infection monitored?
Periodic visits to the doctor and liver function tests will be used to monitor the hepatitis and to see how the liver is working. The status of the liver may require repeated liver biopsies. Decisions about further treatment or liver transplantation are frequently made based on these tests. Any new or worsening symptoms should be reported to the doctor.
Author: Thomas Fisher, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request
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