Hepatitis D Co-infection

Hepatitis D is a viral infection that attacks the liver and causes inflammation. This virus is unique because it cannot survive on its own. It only infects people who already have hepatitis B virus in their body. This is why doctors call it a co-infection.

The hepatitis D virus, or HDV, needs the hepatitis B virus to replicate and spread. When both viruses are present together, the liver damage tends to be more severe. People can get both infections at the same time, called simultaneous infection. They can also get hepatitis D after already having chronic hepatitis B, called superinfection.

Hepatitis D is less common than other types of viral hepatitis. Around 5% of people with hepatitis B worldwide also have hepatitis D. The infection can be acute, meaning short term, or chronic, meaning long lasting. Chronic hepatitis D increases the risk of serious liver problems including cirrhosis and liver failure.

• Fatigue and weakness that does not improve with rest
• Loss of appetite and unexplained weight loss
• Nausea and vomiting
• Abdominal pain, especially in the upper right side
• Dark urine that looks brown or tea-colored
• Pale or clay-colored stools
• Yellowing of the skin and eyes, called jaundice
• Joint pain and muscle aches
• Fever and chills

Many people with hepatitis D do not notice symptoms right away. The virus can cause liver damage for months or years before symptoms appear. Some people only discover they have the infection through routine blood testing.

Hepatitis D spreads through direct contact with infected blood or other body fluids. The most common ways people get infected include sharing needles or syringes for drug use, getting tattoos or piercings with unsterilized equipment, and having unprotected sex with someone who has the virus. Healthcare workers can also get infected through accidental needle stick injuries. The virus can pass from mother to baby during childbirth, though this is less common than with hepatitis B alone.

Your risk is higher if you already have chronic hepatitis B infection. People who inject drugs, have multiple sexual partners, or live with someone who has hepatitis D face increased risk. Men who have sex with men also have higher rates of infection. People who received blood transfusions before widespread screening began in the 1990s may have been exposed. Living in areas where hepatitis D is common, such as parts of the Mediterranean, Middle East, and Africa, also increases exposure risk.

Diagnosing hepatitis D requires specialized blood tests that look for antibodies and viral genetic material. Doctors first test for hepatitis B because hepatitis D cannot exist without it. If hepatitis B tests are positive, your doctor may order additional tests to check for hepatitis D antibodies. These include anti-HDV IgM for recent infection and anti-HDV IgG for past or ongoing infection. A test for HDV RNA confirms active viral replication.

Blood tests like Hepatitis B Core Antibody IgM can indicate recent hepatitis B infection, which is necessary for hepatitis D to occur. However, specialized hepatitis D testing is needed to confirm co-infection. Talk to our doctor about getting the right tests for your situation. Your doctor may also order liver function tests to check how well your liver is working and imaging studies like ultrasound to look for liver damage.

• Antiviral medications like pegylated interferon alpha to slow viral replication and reduce liver inflammation
• Regular monitoring of liver function through blood tests every 3 to 6 months
• Avoiding alcohol completely to prevent additional liver damage
• Maintaining a healthy diet rich in fruits, vegetables, and lean protein
• Getting adequate rest and managing stress levels
• Avoiding medications and supplements that can harm the liver without doctor approval
• Getting vaccinated against hepatitis A to prevent additional liver infections
• Working with a hepatologist, a liver specialist, for ongoing care
• Liver transplant evaluation if severe cirrhosis or liver failure develops