Hepatitis A, B, and C are very well-known in the United States: We have vaccines to prevent HAV and HBV, treatments for HBV, and a cure for HCV, along with a public health infrastructure to monitor and respond to these infections. This article provides an overview of another type of viral hepatitis—hepatitis D (HDV).
It’s hard to get accurate numbers for HDV. There are no established testing or surveillance systems to monitor it. Worldwide, it’s estimated that there are about 12 million people who are living with HDV. Hepatitis D is most common in Eastern and Southern Europe, throughout the Mediterranean and Middle East, and in parts of Asia and Africa. It is rare in the Americas, but it has been found in South America along the Amazon Basin. Although it is very rare in the U.S. it’s estimated that about 3–8% of people living with HBV also have HDV. That said, testing for HDV is low and it is not a reportable disease, so estimates are hard to come by.
What is hepatitis D?
HDV, sometimes referred to as “hepatitis delta,” is a liver infection caused by the hepatitis D virus. It is what’s called a “satellite virus”—that is, it needs something else to make you vulnerable to infection. In this case, only people with hepatitis B can acquire HDV. You can get both viruses at the same time (co-infection), or you can get HDV later after already having HBV (superinfection, meaning one on top of the other).
HBV/HDV co-infection: This is when a person acquires both viruses at the same time. Symptoms may be felt, but most people can fight both viruses off, and fewer than 5% of people will keep infection chronically, when it will not go away.
HBV/HDV superinfection: This is when someone already has HBV, and then later acquires HDV. When this happens, the symptoms can be severe. In superinfection, HDV usually becomes chronic: About 90% of people who get HDV after already having HBV develop an HDV infection that will never go away. People with HBV/HDV superinfection also have a greater chance of developing more severe liver damage over time.
How is hepatitis D transmitted?
Hepatitis D is transmitted much the same way as HBV or HIV—through blood or sexual fluids. Vertical transmission (when the virus is passed to an infant during pregnancy) of HDV is very rare. Hepatitis D can be transmitted the following ways:
- condomless sex
- sharing syringes or other injecting equipment
- other blood to blood contact
- sharing of personal items (such as razors)
You cannot get HDV through casual or household contact from things such as sharing utensils or drinking glasses, hugging someone, or through airborne transmission.
What are the symptoms of hepatitis D?
When people first acquire HDV, also called acute infection, they generally experience the following symptoms:
- fatigue
- nausea and vomiting
- loss of appetite
- liver pain
- jaundice (yellowing of eyes and skin)
- light-colored stool
- dark-colored urine
After acute infection, symptoms tend to disappear, or you get used to them and just go about your life. Over time, however, HBV/HDV infection can lead to more and more scarring of the liver, eventually leading to cirrhosis and an increased risk for liver cancer or liver failure and the need for a liver transplant.
How to prevent hepatitis D?
There is no vaccine to prevent HDV, but since you need to have acquired HBV in order to be vulnerable to HDV infection, getting vaccinated against HBV will protect against HDV.
In the absence of the HBV vaccine, you can prevent HDV infection by doing some of the same things that are done to prevent HBV and HCV (and, for that matter, HIV):
- don’t share syringes or other injecting equipment
- use condoms during sex
- don’t share razors, nail clippers, toothbrushes, or other household items that could have blood on them
Are there treatments or cures for hepatitis D?
There is no cure for HDV. There are treatments, but they can be difficult and are not very effective. Interferon can be used to treat HDV, but the impact on the course of disease is small and the side effects of the treatment can be very debilitating, making the risk-reward of taking it fairly low. There are medications that are under study, but nothing has been approved in the U.S.
While there are ineffective treatments and no cure, it is still important to stay engaged with your medical provider. You may benefit from HBV treatments, but it’s also important to stay engaged with a medical provider so they can monitor the health of your liver, assess you for cirrhosis, and keep an eye on your health until cures become available.
Conclusions
Hepatitis D is very rare in the U.S., and you probably don’t have anything to worry about in terms of having it or being at risk for it. That said, I believe in knowledge and empowering people to make educated choices about their healthcare and prevention needs. Remember, if you don’t have HBV, you can’t get HDV. Get vaccinated against HBV, and you’re good and won’t get HDV. If you’re one of the rare folks who gets both HBV and HDV, stick with a medical provider for monitoring and evaluation, HBV treatment (when necessary), and to assess for liver damage.