What are the symptoms of hepatitis D (HDV)?
Hepatitis D virus (HDV) can cause acute hepatitis, which in most cases occurs as a result of simultaneous infection with hepatitis B virus (HBV).
HDV can also cause chronic viral hepatitis D (HDV), which usually occurs as a result of superinfection in a person who already has hepatitis B (HBV).
Acute viral hepatitis D (HDV)
Symptoms of acute viral hepatitis D (HDV) are very similar to other forms of acute hepatitis.
Three to seven weeks after the initial incidence of infection during which the virus multiplies, the following symptoms can occur: tiredness, loss of appetite and nausea.
The increased number of liver enzymes in the blood indicates destruction of the liver cells. Accompanying symptoms include jaundice (caused by increased levels of bilirubin in the blood), nausea, persistent fatigue, dark urine, clay-coloured stools.
Fulminant (or subacute) viral hepatitis D (HDV)
In exceptional cases, a HDV-HBV superinfection can lead to rapid liver inflammation which can be life-threatening.
These rare exceptional cases are characterised by a sudden and massive destruction of the liver cells. As the destruction of the liver cells progresses, the number of liver enzymes also decreases rapidly. Sudden and severe viral hepatitis D (HDV) usually manifests as jaundice, blood clotting disorders and brain damage (loss of consciousness in the form of confusion, personality changes, drowsiness and entering a state of coma).
In these cases, emergency admission to a specialised centre is absolutely necessary. Liver transplantation can then be suggested as an emergency intervention.
Chronic Viral Hepatitis D (HDV)
Superinfection of viral hepatitis B (HBV) with HDV leads to chronic viral hepatitis D (HDV) infection in up to 90% of all cases. It begins with the acute phase. If the virus has been detected for more than six months, it is referred to as chronic hepatitis.
The disease can be asymptomatic (and detected through accidental diagnosis) or have accompanying symptoms such as tiredness, malaise and loss of appetite. In addition, chronic hepatitis D (HDV) can cause various so-called autoimmune reactions due to a disorder of the immune system.
Chronic hepatitis D (HDV) can lead to liver cirrhosis in 70% of cases in which a patient has been living with the disease for 5 to 10 years. . Cirrhosis of the liver can occur for many years before an individual experiences any symptoms . In the long term, cirrhosis of the liver is a major risk factor for developing liver cancer. However, hepatitis D (HDV) can also lead to liver cancer in the absence of cirrhosis. There is also a risk of liver failure which can be experienced alongside ascites (excess fluid with a person’s abdomen), impaired consciousness or gastrointestinal bleeding due to rupture of esophageal varicose veins.
Sources
Clinical features of hepatitis D. Farci P1, Niro GA. Semin Liver Dis. 2012 Aug;32(3):228-36.
Rizzetto M. Hepatitis D Virus: Introduction and Epidemiology. Cold Spring Harb Perspect Med. 2015 Jul 1;5(7):a021576. doi: 10.1101/cshperspect.a021576
Romeo R et al. 28-Year Study of the Course of Hepatitis Delta Infection: A Risk Factor for Cirrhosis and Hepatocellular Carcinoma. Gastroenterology 2009;136:1629–1638.
Robert Koch Institut. Epidemiologisches Bulleting Nr. 29. Virushepatitis B und D im Jahr 2018. https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2019/Ausgaben/29_19.pdf?__blob=publicationFile. Juni 2020.
G Fattovich 1, G Giustina, E Christensen, M Pantalena, I Zagni, G Realdi, S W Schalm. Influence of hepatitis delta virus infection on morbidity and mortality in compensated cirrhosis type B. The European Concerted Action on Viral Hepatitis (Eurohep) Gut. 2000 Mar;46(3):420-6. doi: 10.1136/gut.46.3.420.
Important stages from diagnosis to therapy
It is difficult to distinguish the symptoms of acute viral hepatitis D from another form of acute hepatitis.
If you have not been vaccinated against hepatitis B (HBV) and are at risk of contracting HBV or HDV , see your doctor for clarification and guidance. If you knowingly become acutely infected with hepatitis B (HBV), there is the possibility of post-exposure prophylaxis, which must be initiated within forty-eight hours
To find out whether you have contracted HBV or HDV, your blood will be tested in a laboratory.
If a HBV infection is confirmed, testing for hepatitis delta (HDV) should then take place immediately. Additionally, you should receive a referral to a liver specialist (hepato-gastroenterologist).
A hepatologist is a medicalspecialists for liver disease who will examine you in the hospital or in a doctor's office.
A HDV test should generally be performed in patients infected with HBV. More liver-specific tests can be done in the hospital.
Based on the results of the additional tests, your hepatologist, supported by a multidisciplinary medical team, will recommend and prescribe an appropriate HBV/HDV treatment.
Depending on the type of treatment prescribed, you will receive this directly at the hospital or you can obtain the medication from a pharmacy.
It is important to take your medication as directed and to read the patient information leaflets carefully.
Your hepatologist will monitor your treatment to check its effectiveness, as well as monitor the progression of the disease to detect any complications or signs of worsening.
Be assured that you are not alone on this journey or in dealing with this disease. It is very important to have someone to talk to. This can be a friend or family member. A patient organisation can also be a helpful contact point.