What Is Hepatitis D? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Hepatitis D, also known as “delta hepatitis,” affects only those who have been exposed to the hepatitis B virus — if you contract both, the one-two punch can cause serious liver problems.

The hepatitis D virus depends on another virus, namely the one that causes hepatitis B, to reproduce itself. This means hepatitis D can only infect people who are already infected with the hepatitis B virus, or who are exposed to hepatitis B at the same time they’re exposed to hepatitis D. (1)

When you are infected with hepatitis B and D at the same time, it’s called coinfection.

If you already have chronic hepatitis B and are then exposed to the hepatitis D virus, it’s called a superinfection. In either case, this double whammy can lead to serious problems. (1)

Hepatitis D can cause significant liver damage and even death, so prevention of this dual infection is crucial. (1)

Hepatitis D can cause an acute or chronic infection, or both. (2) The acute infection lasts a short time, and the chronic infection lasts longer than six months. (3)

People who have acute hepatitis D usually have symptoms, which can include the following: (2)

• Fatigue and lethargy
• Loss of appetite
• Jaundice, which causes a yellowish tint to the whites of the eyes and skin
• Discolored stools and urine
• Pain over the liver, in the upper part of the abdomen

In contrast, the majority of people with chronic hepatitis D will have few symptoms until complications develop. This could be several years after the initial infection. These symptoms can include the following: (2)

• Weakness and fatigue
• Weight loss
• Swelling of the ankles and abdomen
• Itchy skin
• Jaundice

The primary route of transmission for hepatitis D is contact with infected blood or other bodily fluids. This can happen through sharing needles or drug materials with an infected person or having unprotected sex with an infected person. (2)

Although it is rare, hepatitis D can be passed from mother to child during birth. (2)

People can’t get hepatitis D through everyday close contact that doesn’t involve blood or bodily fluids. (2)

Doctors may suspect a person has hepatitis D when the symptoms of acute hepatitis B are unusually severe, chronic hepatitis B gets worse much faster than usual, or when chronic hepatitis B suddenly gets much worse, which would indicate a superinfection. (3)

If hepatitis D is suspected, the doctor will take a medical history to understand factors that may have led to the infection. A physical exam will look for signs of liver damage, which could include jaundice, swelling in the feet or ankles, and swelling or tenderness in the abdomen. (2)

If it’s suspected that a person may have hepatitis D, a blood test that confirms the presence of the antibodies that are produced in response to the infection is required to confirm the diagnosis. (3)

There may be additional tests to determine if there is liver damage as a result of hepatitis B and hepatitis D. The tests can include the following: (2)

• An elastography, which is a special ultrasound that can measure the stiffness of the liver
• A liver biopsy, in which a long needle is used to take a small piece of tissue that will be examined under a microscope to look for signs of disease or damage (2)
• A blood test to measure liver enzyme levels, elevated levels of which often indicate inflammation or damage to the liver cells

Prognosis of Hepatitis D

Your health outlook depends on whether you were coinfected or superinfected with hepatitis D; the prognosis is better for people who were coinfected.

The vast majority of coinfected people experience only the acute phase of the disease; most of these people will get better over two to three weeks. Liver enzyme levels typically return to normal within four months. (4)

About 10 percent of people infected with hepatitis D develop a chronic liver infection. (4)

Chronic hepatitis D leads to cirrhosis, or scarring of the liver, in about 70 to 80 percent of cases. (5,6) Once a person has cirrhosis, the disease may remain stable for as long as 10 years, although a high percentage of people with chronic hepatitis D and cirrhosis eventually die of acute liver failure or liver cancer unless they get a liver transplant.

The overall mortality rate of hepatitis D is unclear, with estimates placing it between 2 and 20 percent. As with most forms of hepatitis, prevention is the best strategy. (7)

Acute hepatitis D is short-lived and usually goes away in less than a month. (4)

Though most people are able to recover from hepatitis D, if it does become chronic it is a long-lasting infection that may not go away. (2)

Medications are not effective against acute hepatitis D, but fortunately, the acute infection tends to subside on its own.

As for chronic hepatitis D, appropriate treatment depends on the phase of the disease and how severely the infection affects liver function.

If a person’s liver is severely damaged, a liver transplant may become necessary.

While treatment options for hepatitis D are limited, new medications are being studied. However, there is currently no Food and Drug Administration (FDA)-approved drug for hepatitis D in the United States.

Medication Options

Doctors may prescribe a drug called interferon alfa or, alternatively, one called pegylated interferon alfa, for chronic hepatitis D.

Interferons are naturally occurring proteins that are made and secreted by cells of the immune system. Those used to treat disease are human interferons manufactured using recombinant DNA technology.

Given in high doses for one year, interferon can put chronic hepatitis D into remission, but usually does not completely rid the body of infection. (8)

A few new antiviral agents that target various stages of chronic hepatitis D are showing promising results. A drug known as bulevirtide (Hepcludex) was approved by the European Commission for the treatment of hepatitis D, (9) although it has not been approved by the FDA due to production and delivery concerns, outlined in a notice to the drug’s manufacturer.

Complementary and Integrative Approaches/Therapies

Studies on complementary therapies, such as herbal therapies, are lacking for the treatment of hepatitis D, and they have not been shown to be effective for other forms of viral hepatitis, such as hepatitis C.

People who have hepatitis D are recommended to follow a healthy diet, avoid alcohol, and avoid supplements with any liver risk, because these can potentially help reduce harm to the liver. (2)

Prevention of Hepatitis D

Although there is no vaccine for hepatitis D, an effective vaccine does exist for hepatitis B. Since hepatitis D cannot survive without hepatitis B, a vaccination against hepatitis B will protect you from both strains.

It’s important to note that the hepatitis B vaccine is only effective at preventing coinfection, not superinfection. (2)

If you already have hepatitis B, other prevention strategies will help you avoid hepatitis D.

You can prevent hepatitis D and other bloodborne illnesses like hepatitis C and HIV by avoiding these high-risk behaviors: (2)

• Sharing intravenous drug paraphernalia
• Having unprotected sex
• Sharing personal-care items with a person who has hepatitis D, especially those items that may have trace amounts of blood on them, such as razors or toothbrushes.

If you have hepatitis D you shouldn’t donate blood or blood products, sperm, organs, or tissue. (2)

The potential complications of a hepatitis D infection include progressively serious liver conditions.

Cirrhosis of the Liver

Chronic hepatitis D can lead to cirrhosis, which is when the liver slowly breaks down. Scar tissue replaces healthy liver tissue, which blocks the flow of blood. Gradually, the liver is able to function less and less. (2)

If cirrhosis is diagnosed early and the underlying cause is treated, the damage can be halted and in some rare cases, reversed. (10)

Liver Failure

Liver failure means that the liver is losing or has already lost the ability to function. This condition could lead to death and needs immediate and urgent medical attention.

Liver failure can be caused by cirrhosis or malnutrition. (11)

Hepatocellular Carcinoma

People who have had their liver scarred by viral hepatitis are at a higher type of risk for hepatocellular carcinoma, the most common type of primary liver cancer. Treatment and prognosis depend on the size and location of the cancer, the level of liver function, and a person’s overall health. (12)

Hepatitis D was first identified as a distinct form of hepatitis in 1977. (13) A systematic review and meta-analysis published in 2020 estimated its worldwide prevalence at 12 million people. (14)

Hepatitis D is rare in the United States, and most cases occur among people who migrate or travel to the United States from countries that have a higher rate of the hepatitis D virus.

Hepatitis D is not a nationally notifiable condition, so the actual number of people who have it is unknown. (15)

Results from a 2011–2016 national study found that approximately 0.11 percent of the more than 21,000 subjects age 6 or older had antibodies, which would indicate they had a hepatitis D infection. That would correspond to approximately 357,000 people in the United States with a past or ongoing hepatitis D infection. (16)

The researchers found that the prevalence of hepatitis D is highest in Asian Americans and people born outside the United States. (16)

Because hepatitis D is not a nationally notifiable condition, it is unclear whether it affects Black, Indigenous, and People of Color (BIPOC) populations any differently from white Americans. There is data available on hepatitis B, however, which a person has to have to be infected with hepatitis D.

Black Americans and Hepatitis B

Centers for Disease Control and Prevention (CDC) statistics show that Black and white Americans had the same rate of acute hepatitis B infection in 2018. (17)

CDC statistics also show that Black adults had a lower rate of chronic hepatitis B infection than white adults between 2013 and 2016, a much higher hepatitis B–related death rate in 2016, and a lower HBV vaccination rate in 2015. (18)

The percentage of Black adolescents ages 13 to 17 who had ever received three or more doses of the hepatitis B vaccination was the same as the percentage of white adolescents in 2016. (18)

And the percentage of Black and white children ages 19 to 35 months who had received three doses of hepatitis B vaccine in 2016 was the same. (18)

Data collected in 2009 and 2010 from the Racial and Ethnic Approaches to Community Health across the United States suggests that there are disparities in care when it comes to hepatitis B screening, referral to care, and the initiation of antiviral therapy. (19) In a 2020 update, the rate of acute hepatitis B continues to be similar among non-Hispanic white and non-Hispanic Black persons (0.7 cases per 100,000 population for each).

Hispanic Americans and Hepatitis B

Adult Hispanic Americans have a lower rate of chronic hepatitis B infection, according to CDC statistics, and they die from hepatitis B–related causes at the same rate as adult white Americans. Among adults ages 19 to 49, vaccination coverage was lower for Hispanic than for white Americans in 2015, but among Hispanic and white adolescents ages 13–17 years and children age 19 to 35 months, it was the same in 2016. (20)

Asian Americans and Pacific Islander Communities and Hepatitis B

In 2020, the rate of newly reported chronic hepatitis B cases was highest among Asian American and Pacific Islander people (17.6 cases per 100,000 population), which was 12 times the rate among non-Hispanic White people (1.5 cases per 100,000 population).

The condition most closely related to hepatitis D is hepatitis B, a liver infection caused by the hepatitis B virus (HBV) and spread from person to person through blood, semen, or other body fluids.

There is a vaccine available to prevent hepatitis B. For some people, HBV is a short-term illness and for others it can be a long-term, chronic infection that can have life-threatening complications such as cirrhosis or liver cancer. (21)

A person must be infected with HBV to contract hepatitis D.

These organizations can provide more information about hepatitis D, including its transmission, symptoms, diagnosis, treatment, and complications.

Centers for Disease Control and Prevention (CDC)

The government agency provides information for both healthcare providers and the public, including a list of questions and answers about hepatitis D.

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

This government organization provides research and funding for diseases that are among the most chronic, costly, and consequential for U.S. patients and their families. The website offers current information about hepatitis D.

World Health Organization (WHO)

This organization focuses on improving health around the world. They provide guidance, resources, and recommendations about diseases, including hepatitis D.

Additional reporting by Becky Upham.