Hepatitis D

An overview of viral hepatitis, including a table comparing the clinical features of hepatitis A, B, C, D and E, is provided here.

Hepatitis D virus (hepatitis delta virus, HDV) can only establish infection in the presence of hepatitis B virus (HBV) co-infection. Although the prevalence of hepatitis D varies, it has been estimated that approximately 5% of patients with chronic hepatitis B (at least 15 to 20 million patients worldwide) are co-infected with hepatitis D. A similar proportion of people living with chronic hepatitis B in Australia are believed to be co-infected with hepatitis D.

All people diagnosed with chronic hepatitis B should be tested for hepatitis D infection by measuring hepatitis D antibodies (anti-HDV) at baseline. Testing may also be indicated when a patient with hepatitis B has an acute flare of hepatitis without a clear cause, or when there is progressive liver disease despite treatment. Those who are HDV antibody positive should have HDV RNA viral load testing.

In people with chronic hepatitis B, co-infection with hepatitis D can be associated with more rapid progression to advanced liver disease. Oral antiviral therapies (eg entecavir, tenofovir) for hepatitis B have no impact on hepatitis D (but may be required to manage the chronic hepatitis B co-infection). Peginterferon for at least 48 weeks is effective in a minority of patients. Consultation with an expert in the management of hepatitis B and hepatitis D infection is recommended.