Hepatitis D laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]

Laboratory Findings

Diagnostic Markers	Significance
Anti-HDV IgG antibody	Positive in persons exposed to HDV Persists, even after viral clearance
Anti-HDV IgM antibody	Positive in acute infection Negative in past infection Persists in many patients with chronic infection
HDV RNA	Qualitative Marker of HDV replication Positive in chronic infection Negative in spontaneous or treatment-induced viral clearance Quantitative Useful in monitoring or predicting treatment response
HBsAg	Qualitative Must be positive for HDV infectivity Quantitative Positively correlated with HDV RNA Falling titer signals HBsAg loss, and hence HDV clearance Useful in monitoring or predicting treatment response
HBeAg	Negative in an estimated 85% of patients Associated with detectable anti-HBe
HBV DNA	Quantitative Suppressed by HDV Negative or low levels in most patients May be increased in patients with detectable HBeAg Can reactivate after spontaneous or treatment-induced clearance of HDV
ALT	Increased in most patients Does not correlate well with degree of histological liver damage

Anti-HDV antibodies are present in all persons infected with HDV. All patients positive for HBsAg should be tested for anti-HDV IgG antibodies. Active HDV infection is confirmed by the detection of serum HDV RNA with sensitive real-time PCR assay.

• Detection of HDV RNA using reverse transcriptase polymerase chain reaction assay has a high sensitivity in detection of HDV viremia.
• HDV antigen may be detected.
• Levels of anti-delta agent antibodies such as IgM and IgG are generally be elevated. Detection of IgA antibodies to HDV is exclusively associated with chronic HDV infection.
• Patients may also be positive for HBsAg and anti-HB core IgM. However HBsAg levels may be suppressed to undetectable levels with active HDV replication.
• Liver function tests may generally show elevated serum alanine aminotransferase and aspartate aminotransferase levels.
• Elevated international normalized ratio (INR) with prolongation of prothrombin time suggests fulminant hepatic failure.