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what is hep d?

Hepatitis delta is a largely blood-borne inflammatory liver
disease dependent on hep B1,2

Hepatitis delta occurs only in the presence of the hepatitis B virus (HBV)1

HDV Infection (Mechanism of Disease)

HDV structure and function4

HDV particle consisting of 2 HDV antigen isoforms
in a lipid envelope of HBsAg proteins

Drawing of a hepatitis delta virus infecting a hepatocyte.

HDV attaches to the NTCP receptor to enter
the hepatocyte cell and propagate

Clinical presentation varies widely, with some patients
showing acute symptoms and others fully asymptomatic2

Elevated liver enzymes may signal HDV in asymptomatic patients
with low levels of hepatitis B5

Elevated ALT or AST with low or undetectable hep B may be a sign of HDV

Symptoms are similar to other forms of viral hepatitis and include2

  • Fever
  • Fatigue
  • Loss of appetite
  • Nausea
  • Vomiting
  • Dark urine
  • Jaundice
  • Pale-colored stools

Hepatitis delta cannot be diagnosed based on symptoms or disease progression alone—antibody testing is imperative1

Persons from endemic regions are
at the most significant risk for HDV6,7

Map of endemic countries

Other populations at risk for hep D include1,2:

  • Sex partners, household contact with people with HDV, and infants born to people with HDV
  • Healthcare workers at risk for exposure to blood or blood-contaminated body fluids
  • Sex workers
  • Hemodialysis patients

AASLD guidelines contain a full list of populations at high risk for hepatitis D infection.

Hep D can be spread through percutaneous or mucosal contact with infectious blood or body fluids1

Spread can occur through any of the following:

Sex with an infected partner

Men who have sex with men

Injection drug use that involves sharing needles, syringes, or drug-preparation equipment

Contact with blood from an infected person

Needle sticks or exposures to sharp instruments

Sharing items like razors and toothbrushes with an infected person

HDV superinfection frequently leads to chronic infection3

  • Superinfection occurs when a person acquires HDV while already chronically infected with HBV
  • Superinfection is more prevalent than coinfection, which occurs when a person acquires HBV and HDV at the same time
Pie chart of 10% spontaneous clearance and 90% chronic infection

90% of superinfected adults are chronically infected and 10% have spontaneous clearance

Keep up to date on news and info about hepatitis D and its management


Questions about hep B?


AASLD=American Association for the Study of Liver Diseases; ALT=alanine aminotransferase; AST=aspartate aminotransferase; HBsAg=hepatitis B surface antigen.

References: 1. Centers for Disease Control and Prevention. Hepatitis D questions and answers for health professionals. Updated March 9, 2020. Accessed August 9, 2021. 2. World Health Organization. Hepatitis D fact sheet. Updated July 28, 2021. Accessed August 9, 2021. 3. Farci P, Niro GA. Clinical features of hepatitis D. Semin Liver Dis. 2012;32(3):228-36. doi:10.1055/s-0032-1323628 4. Koh C, Heller T, Glenn JS. Pathogenesis of and new therapies for hepatitis D. Gastroenterology. 2019;156(2):461-476. doi:10.1053/j.gastro.2018.09.058 5. Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67:1560-1599. doi:10.1002/hep.29800 6. Toy M, Ahishalı E, Yurdaydın C. Hepatitis delta virus epidemiology in the industrialized world. AIDS Rev. 2020;22:203-212. doi:10.24875/AIDSRev.20000056 7. Miao Z, Zhang S, Ou X, et al. Estimating the global prevalence, disease progression, and clinical outcome of hepatitis delta virus infection. J Infect Dis. 2020;221(10):1677-1687. doi:10.1093/infdis/jiz633