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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 requires the presence of the Hepatitis B virus in order to cause an infection. The Hepatitis D virus is therefore called a "defective" virus. It cannot infect the liver without Hepatitis B.

These two viruses may be acquired at the same time (this is called co-infection). Also, a person may already have a chronic Hepatitis B infection, and then become infected with Hepatitis D (this is called super-infection). Hepatitis D was formerly called the "delta agent".

What is going on in the body?

• filtering the blood
• making bile, a substance that helps digest fat and excrete certain fatty substances
• processing and hooking fats to carriers (cholesterol), and storing sugars, helping the body transport and save energy
• making important proteins, such as most of those involved in blood clotting
• metabolizing many medications, such as barbituates, sedatives, and amphetamines
• storing iron, copper, vitamins A andD, and several of the B vitamins
• making important proteins like albumin that regulate fluid transport in the blood and kidneys
• helping break down and recycle red blood cells

Infection of the liver by viruses can result in liver inflammation, known as hepatitis. The inflammation can damage the liver cells and interfere with their normal function. Hepatitis that comes on quickly and is occasionally severe is called acute hepatitis. Hepatitis that progresses slowly and lasts a long time is called chronic hepatitis. Hepatitis D can damage the liver:

• through direct liver cell damage
• through inflammation, which is caused by the immune system attacking the virus

Someone who has immunity to the Hepatitis B virus is also protected from the Hepatitis D virus.

What are the signs and symptoms of the infection?

• nausea
• jaundice. This skin yellowing usually lasts a week or two, accompanied by darkened urine.
• malaise, or a vague feeling of illness
• fatigue
• pain in the right upper part of the stomach
• myalgiaz (muscle soreness)
• mild fever
• a somewhat enlarged and tender liver
• weight loss as a result of loss of appetite

Hepatitis D virus infection can be severe when it occurs simultaneously in someone who has acquired Hepatitis B. This acute fulminant form of hepatitis involves severe liver cell destruction and loss of liver function and can be fatal.

• an enlarged, painful liver
• enlarged spleen
• severe jaundice
• susceptibility to bleeding
• encephalopathy, a disorder in the functioning of the brain due to toxic substances
• aplastic anemia in rare cases. Aplastic anemia is a condition in which the bone marrow cannot make enough red or white blood cells or platelets.

Chronic liver disease, which may occur with Hepatitis D and B together, often has few early symptoms. At times there may be mild flare-ups with jaundice, nausea, fatigue, and weight loss. However, the combination of B and D virus infection over time makes it more likely for the patient to develop cirrhosis and liver cancer.

What are the causes and risks of the infection?

• 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 before donor screening became routine, or in a world area where donor screening is not standard practice

Each year, fewer cases are reported due to use of the Hepatitis B vaccine. Thise who receive the Hepatitis B vaccine are also protected from Hepatitis D.

What can be done to prevent the infection?

Right now, there is no vaccine for Hepatitis D. The best way to prevent the Hepatitis D virus is to prevent Hepatitis B. This can be done by getting the Hepatitis B vaccine and avoiding at risk behaviors completely..

How is the infection diagnosed?

The healthcare provider may suspect Hepatitis D after doing a physical examination and checking liver function tests, especially if the patient already has evidence of Hepatitis B. 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. This test measures antibodies to Hepatitis D. Since hepatitis B, C, D and the human immunodeficiency virus all share the same transmission risks, patients may infected with all of them.

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 monitor response to therapy.

What are the long-term effects of the infection?

Chronic liver disease and cirrhosis occur more commonly with Hepatitis D infection than with Hepatitis B alone. Cirrhosis is a serious disease that causes scarring of the liver. Liver cancer is another known complication of Hepatitis B and D infections. 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 (called vertical transmission), or transmitted by contact with infected blood or bodily fluids.

What are the treatments for the infection?

• bed rest
• drinking extra fluids to prevent dehydration
• avoiding medications potentially toxic to the liver such as acetaminophen (Tylenol)
• avoiding alcohol
• eating a well balanced diet for liver disease
• taking medications for nausea when needed

For sudden, severe Hepatitis D, hospitalization may be necessary. A person with acute Hepatitis B and D may require antibiotics, vitamin K injections, blood and plasma transfusions, and fluids. Progressive liver failure may necessitate a liver transplant.

For chronic Hepatitis D, treatment may include the antiviral drug alpha interferon (or pegylated interferon), which may help if cirrhosis has not developed. It is not always an effective treatment. Some people with end-stage liver disease from Hepatitis B and D may need a liver transplant. Hepatitis can recur in the transplanted liver.

What are the side effects of the treatments?

Side effects will depend on the treatments used. Side effects of interferon include depression or mood changes, a flu-like illness, with fever and body aches, and interference with new blood cell production in the bone marrow.

A liver transplant can be followed by many complications, including failure or rejection of the new liver. After a liver transplant, a person will need to take powerful anti-rejection 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 conditions.

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.

How is the infection monitored?

During periodic visits, the healthcare provider will monitor the extent of a person's liver damage using liver function tests. 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 healthcare provider.