Makindo Medical Notes.com

It is a unique virus that requires the presence of the hepatitis B virus (HBV) to replicate and infect the liver. HDV is considered the most severe form of viral hepatitis due to its potential to cause rapid progression to cirrhosis, liver failure, and hepatocellular carcinoma.

About

• Cause of hepatitis dependent on the presence of HBV
• Complications are as for HBV - cirrhosis and liver failure
• Prevention of Hepatitis B effectively prevents hepatitis D
• IV drug users

Aetiology

• HDV can only infect individuals who are already infected with hepatitis B.
• is an RNA defective virus dependent on the presence of HBV.
• An incomplete RNA virus within a shell of HBsAg
• Can only replicate with Hepatitis B

Transmission

• Blood-to-Blood Contact: Sharing needles, transfusions with contaminated blood, or exposure to infected blood.
• Unprotected Sexual Contact: Especially with multiple partners or with an HBV-infected partner.
• Perinatal Transmission: From mother to child during childbirth, though less common than with HBV alone.

Clinical

• Fatigue: Persistent and severe tiredness.
• Jaundice: Yellowing of the skin and eyes.
• Abdominal Pain: Especially in the upper right quadrant, where the liver is located.
• Dark Urine: Due to the presence of bilirubin.
• Nausea and Vomiting: Common gastrointestinal symptoms.
• Loss of Appetite: Decreased desire to eat.
• Joint Pain: Generalized or specific joint pain

Investigations

• HDV RNA Test: Detects the genetic material of the HDV virus in the blood, confirming active infection.
• Anti-HDV Antibodies: Indicates current or past infection with HDV.
• Liver Function Tests: ALT, AST, bilirubin, and albumin.
• HBsAg Test: the presence of hepatitis B surface antigen (HBsAg) is necessary for the diagnosis of HDV.

Management

• Interferon Therapy: Pegylated interferon-alpha is currently the most common treatment, but it has limited efficacy and can have significant side effects. Treatment is often prolonged and may not lead to a cure.
• Antiviral Therapy for HBV: Since HDV depends on HBV, controlling HBV with antivirals (e.g., tenofovir, entecavir) is important but doesn't directly affect HDV replication.
• Liver Transplantation: liver failure or severe cirrhosis, liver transplantation may be necessary.
• Emerging Therapies: Research is ongoing into new treatments, including drugs that inhibit HDV entry into liver cells or target specific steps in HDV replication. Bulevirtide, a new antiviral drug, has shown promise in treating HDV and has been approved in some regions.

Prevention

• The best way to prevent HDV is to prevent HBV infection
• Hepatitis B Vaccination and safe sex and needles practice