Hepatitis D

What is hepatitis D?

Hepatitis D is a viral infection that causes liver inflammation. You can get it at the same time as a hepatitis B infection or after you’ve already been infected with hepatitis B. You can’t get infected with hepatitis D on its own.

A hepatitis D infection can be acute or chronic. Symptoms of an acute infection can come on quickly and last for a few weeks or months. Acute infections can become chronic, which means that your symptoms last longer than six months.

Types of hepatitis D

Types of hepatitis D infection include:

• Coinfection: A coinfection is when you get infected with hepatitis D virus (HDV) at the same time as hepatitis B virus (HBV). The symptoms of both infections are the same, though they might be more severe if you get them both at the same time.
• Superinfection: A hepatitis D superinfection happens when you already have an HBV infection and you later become infected with hepatitis D. Since superinfections happen after your initial infection with HBV, your symptoms may suddenly come back or get more severe. Superinfections are more likely to lead to chronic (long-term) illness.

What are the symptoms of hepatitis D?

Symptoms of hepatitis D are similar to other types of hepatitis. They include:

• Fever.
• Belly (abdominal) pain.
• Nausea and vomiting.
• Loss of appetite.
• Dark pee (urine).
• Pale or gray poop (stool).
• Yellow tinge to your skin or eyes (jaundice).

Hepatitis D can also make existing hepatitis B symptoms worse.

What causes hepatitis D?

Hepatitis virus type D, also called hepatitis delta or HDV, causes hepatitis D. It needs hepatitis B virus (HBV) to survive and make more copies of itself. You can only get an HDV infection while you already have an HBV infection or at the same time as an initial HBV infection.

How do you get hepatitis D?

You can get hepatitis D if you come in contact with infected blood or body fluids. Examples of ways hepatitis D can spread include:

• Vaginal, oral and anal sex.
• Sharing needles (or other equipment) to inject drugs or medications.
• Accidental needle sticks.
• Childbirth (from an infected pregnant person to their baby). This is rare.

What are the risk factors for hepatitis D?

You’re at a higher risk for hepatitis D if you:

• Inject drugs.
• Have a sex partner who has HBV and HDV.
• Live with someone who has HBV and HDV.
• Have HIV.
• Are a man who has sex with men.
• Work in healthcare or another field that puts you in contact with body fluids.
• Are on hemodialysis.

What are the complications of hepatitis D?

Complications of hepatitis D include:

• Liver scarring (cirrhosis).
• Liver failure.
• Hepatocellular carcinoma, a type of liver cancer.

How is hepatitis D diagnosed?

Healthcare providers use blood tests to diagnose hepatitis D. A lab looks for signs of the virus or antibodies to it in your blood. They may also get imaging tests like an abdominal ultrasound or elastography to check your liver for signs of scarring.

Is there a cure for hepatitis D?

There’s no treatment that cures hepatitis D. Acute HDV infections can go away without treatment. For chronic hepatitis D, providers may treat you with:

• Peginterferon injections. This is a medication that helps your immune system fight infections.
• Bulevirtide (Hepcludex^®). This antiviral medication is approved for HDV treatment in certain countries. It’s not approved for use in the U.S.
• Liver transplant. If your liver is severely damaged, you may need a transplant.

Can you prevent hepatitis D?

You can reduce your risk of a coinfection with hepatitis D and hepatitis B by getting vaccinated for hepatitis B. There are no specific vaccines for hepatitis D. If you think you’ve been exposed to hepatitis B, you can still get vaccinated and treated with hepatitis B immune globulin (HBIG), which can help prevent you from getting infected.

If you have hepatitis B, you can reduce your risk of a superinfection by:

• Wearing sterile gloves if you might come in contact with infected blood, pus from sores, or other body fluids.
• Not sharing needles or other equipment for injecting drugs.
• Not sharing personal items.
• Wearing a condom during any kind of sex.
• Taking antiviral medication to treat hepatitis B, if recommended by your provider.

If you’re pregnant and have hepatitis B or an HBV/HDV infection, healthcare providers can vaccinate and treat your baby soon after birth to reduce their risk of developing an infection.

What can I expect if I have hepatitis D?

If you have hepatitis D, a healthcare provider will monitor your liver health through regular checkups and testing. They’ll look for signs of liver disease and check your liver function. Acute hepatitis D or HBV/HDV infection can last for a few weeks or months, but it can get better without treatment.

Most people with a superinfection progress to chronic hepatitis. Chronic hepatitis D lasts six months or longer. Your provider may treat you for a year or longer.

What’s the prognosis (outlook) for hepatitis D?

Acute HBV/HDV infections are rarely fatal. But they can take weeks or months to get better.

Up to 70% of people with chronic HBV/HDV infections will eventually develop liver scarring. This can happen quickly — within the first two years of infection — or take up to 10 years to develop. About 25% (or one-quarter) of people with chronic hepatitis B die of complications like liver cancer.

How do I take care of myself?

If you have hepatitis, there are steps you can take to reduce your risk of liver damage. These include:

• Avoid alcohol. Alcohol can damage liver cells when your liver processes it.
• Don’t smoke or quit smoking.
• Maintain a weight that’s healthy for you. Ask your provider about foods you should eat and any that you should avoid to help keep your liver healthy.
• Ask your provider what over-the-counter (OTC) medications are safe to take. They may suggest limiting how often you take certain medications, like acetaminophen (Tylenol^®).
• Attend all appointments with your healthcare providers and get all recommended tests to monitor your liver health.

When should I see my healthcare provider?

Talk to your healthcare provider if you have symptoms of hepatitis or if you have hepatitis B and your symptoms suddenly get worse.

When should I go to the ER?

Go to the emergency room if you have these signs of severe illness:

• Severe abdominal pain.
• Severe vomiting or being unable to keep anything down.
• Vomiting blood or vomit that looks like coffee grounds.
• Jaundice.
• Confusion or altered mental state (hepatic encephalopathy).
• Dark-colored pee or peeing very little.
• Clay or light-colored poop.

What questions should I ask my doctor?

It might be helpful to ask a healthcare provider:

• What are my treatment options?
• How long will I need to be on this treatment?
• How do I take/use this medication?
• Are there any new or worsening symptoms I should look out for?
• How can I prevent hepatitis D if I have hepatitis B?

What’s the difference between hepatitis B and D?

Hepatitis B and D are two different viral infections. But hepatitis D can only infect you at the same time as hepatitis B, or if you already have a hepatitis B infection. Most people with hepatitis B don’t have hepatitis D.

How common is hepatitis D?

Experts estimate about 5% to 15% of people with hepatitis B worldwide — or about 12 to 45 million people — also have an HDV infection. Hepatitis D is most common in parts of Africa, Asia, Europe and the Amazon River basin in South America. It isn’t common in the U.S. or the rest of North America.