Hepatitis D natural history: Difference between revisions
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==Natural History== | ==Natural History== | ||
HDV requires an associated HBV infection. After an initial incubation of 3-7 weeks, the preicteric phase of acute HDV occurs with symptoms of fatigue, lethargy, anorexia, and nausea lasting 3 to 7 days. ALT and AST levels elevate at this stage. Following the preicteric phase, the icteric phase is characterized by the manifestation of jaundice, acholic stools and dark urine | HDV requires an associated HBV infection. After an initial incubation of 3-7 weeks, the preicteric phase of acute HDV occurs with symptoms of fatigue, lethargy, anorexia, and nausea lasting 3 to 7 days. ALT and AST levels elevate at this stage. Following the preicteric phase, the icteric phase is characterized by the manifestation of jaundice, acholic stools and dark urine. Serum bilirubin levels elevate. Fatigue and nausea continue to be present. | ||
===Co-infection=== | ===Co-infection=== | ||
Revision as of 23:02, 5 August 2014
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Hepatitis D |
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Diagnosis |
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Treatment |
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Hepatitis D natural history On the Web |
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American Roentgen Ray Society Images of Hepatitis D natural history |
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Risk calculators and risk factors for Hepatitis D natural history |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]
Overview
The clinical manifestations of HDV infection are similar to those of HBV infection, although infection with both may progress to more severe liver disease compared with HBV.
Natural History
HDV requires an associated HBV infection. After an initial incubation of 3-7 weeks, the preicteric phase of acute HDV occurs with symptoms of fatigue, lethargy, anorexia, and nausea lasting 3 to 7 days. ALT and AST levels elevate at this stage. Following the preicteric phase, the icteric phase is characterized by the manifestation of jaundice, acholic stools and dark urine. Serum bilirubin levels elevate. Fatigue and nausea continue to be present.
Co-infection
Co-infection of HBV and HDV results in both acute type B and acute type D hepatitis. The incubation depends on the HBV titer of the infecting inoculum. One or two bouts of hepatitis may be seen depending on the relative titers of HBV and HDV. Coinfections are usually acute and self limiting. The chronic form of hepatitis D is seen in less than 5% of co-infected patients.
Superinfection
HDV superinfection among persons with chronic HBV infection results in chronic HDV a majority of the time while less frequently, HDV replication stops and the natural history becomes that of the HBV infection. In cases where HDV replication stops, residual liver disease may still be more advanced.
Superinfection can present as acute hepatitis in a previously undiagnosed carrier of HBsAg. It is often misdiagnosed as acute HBV or as chronic HBV causing a worsening of the liver disease.
With HBV and HDV co-infection, the fate of HDV is determined by the hosts response to HBV. In more than 95% of adults, HDV is cleared. Acute co-infection can be more severe than acute mono-infection with HBV, although disease expression is wide ranging.
HDV superinfection among persons with chronic HBV infection results in chronic HDV a majority of the time while less frequently, HDV replication stops and the natural history becomes that of the HBV infection.
Complications
- Chronic active hepatitis
- Fulminant hepatitis
- Hepatic cirrhosis
- Hepatic failure
- Hepatocellular carcinoma
Prognosis
Persons with an acute HDV infection usually get better over 2 to 3 weeks. Liver enzyme levels return to normal within 16 weeks. About 10% of those who are infected may develop long-term (chronic) liver inflammation (hepatitis).
Exposure to hepatitis D may worsen the symptoms of hepatitis B. Patients with co-infection are more likely to have fulminant hepatitis than those patients with HBV infection alone.
When acute infection with HDV occurs in the face of an existing chronic HBV infection, especially in persons with progressive, symptomatic chronic disease, there is increased progression of hepatic cirrhosis and hepatic failure. Both co-infection of hepatitis D and hepatitis B, as well as superinfection of hepatitis D, have been associated with fulminant hepatitis. Hepatitis D results in death in between 2 and 20 percent of patients with acute icteric hepatitis.[1]
References
- ↑ Center for Substance Abuse Treatment. Screening for Infectious Diseases Among Substance Abusers. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1993. (Treatment Improvement Protocol (TIP) Series, No. 6.) Chapter 15 - Viral Hepatitis D.