Hepatitis D laboratory findings: Difference between revisions
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==Laboratory Findings== | ==Laboratory Findings== | ||
[[Hepatitis D]] should be considered in any individual who is [[HBsAg]] positive or that has evidence of recent [[HBV infection]]. The [[diagnosis]] of acute [[hepatitis D]] is made after evaluation of [[serologic]] tests for the [[HDV|virus]]. Persons infected with [[HDV]] develop anti-HDV antibodies. Accordingly, every individual with an [[HBsAg]] positive test result, should be studied for the presence of anti-HDV [[IgG]] antibodies.<ref name="pmid21511329">{{cite journal| author=Hughes SA, Wedemeyer H, Harrison PM| title=Hepatitis delta virus. | journal=Lancet | year= 2011 | volume= 378 | issue= 9785 | pages= 73-85 | pmid=21511329 | doi=10.1016/S0140-6736(10)61931-9 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21511329 }} </ref> | [[Hepatitis D]] should be considered in any individual who is [[HBsAg]] positive or that has evidence of recent [[HBV infection]]. The [[diagnosis]] of acute [[hepatitis D]] is made after evaluation of [[serologic]] tests for the [[HDV|virus]]. Persons infected with [[HDV]] develop anti-HDV antibodies. Accordingly, every individual with an [[HBsAg]] positive test result, should be studied for the presence of anti-HDV [[IgG]] antibodies.<ref name="pmid21511329">{{cite journal| author=Hughes SA, Wedemeyer H, Harrison PM| title=Hepatitis delta virus. | journal=Lancet | year= 2011 | volume= 378 | issue= 9785 | pages= 73-85 | pmid=21511329 | doi=10.1016/S0140-6736(10)61931-9 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21511329 }} </ref> These antibodies usually persist in circulation, however they may become negative in some patients. | ||
The active form of the [[HDV infection]] was initially diagnosed by the detection of anti-HDV [[IgM]] antibodies. However, today the acute [[infection]] is confirmed with [[real-time PCR]], by detecting [[serum]] [[HDV]] [[RNA]].<ref name="pmid20351206">{{cite journal| author=Mederacke I, Bremer B, Heidrich B, Kirschner J, Deterding K, Bock T et al.| title=Establishment of a novel quantitative hepatitis D virus (HDV) RNA assay using the Cobas TaqMan platform to study HDV RNA kinetics. | journal=J Clin Microbiol | year= 2010 | volume= 48 | issue= 6 | pages= 2022-9 | pmid=20351206 | doi=10.1128/JCM.00084-10 | pmc=PMC2884474 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20351206 }} </ref> | The active form of the [[HDV infection]] was initially diagnosed by the detection of anti-HDV [[IgM]] antibodies. However, today the acute [[infection]] is confirmed with [[real-time PCR]], by detecting [[serum]] [[HDV]] [[RNA]].<ref name="pmid20351206">{{cite journal| author=Mederacke I, Bremer B, Heidrich B, Kirschner J, Deterding K, Bock T et al.| title=Establishment of a novel quantitative hepatitis D virus (HDV) RNA assay using the Cobas TaqMan platform to study HDV RNA kinetics. | journal=J Clin Microbiol | year= 2010 | volume= 48 | issue= 6 | pages= 2022-9 | pmid=20351206 | doi=10.1128/JCM.00084-10 | pmc=PMC2884474 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20351206 }} </ref> | ||
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===Genotyping=== | ===Genotyping=== | ||
The use of [[genotyping]] as a diagnostic test is gaining acceptance among different countries, due to the association of [[HDV]] [[genotype]] 1 to a higher degree of [[liver disease]] and to a worst response to treatment with pegylated IFN.<ref name="pmid16697726">{{cite journal| author=Su CW, Huang YH, Huo TI, Shih HH, Sheen IJ, Chen SW et al.| title=Genotypes and viremia of hepatitis B and D viruses are associated with outcomes of chronic hepatitis D patients. | journal=Gastroenterology | year= 2006 | volume= 130 | issue= 6 | pages= 1625-35 | pmid=16697726 | doi=10.1053/j.gastro.2006.01.035 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16697726 }} </ref> | The use of [[genotyping]] as a diagnostic test is gaining acceptance among different countries, due to the association of [[HDV]] [[genotype]] 1 to a higher degree of [[liver disease]] and to a worst response to treatment with pegylated IFN.<ref name="pmid16697726">{{cite journal| author=Su CW, Huang YH, Huo TI, Shih HH, Sheen IJ, Chen SW et al.| title=Genotypes and viremia of hepatitis B and D viruses are associated with outcomes of chronic hepatitis D patients. | journal=Gastroenterology | year= 2006 | volume= 130 | issue= 6 | pages= 1625-35 | pmid=16697726 | doi=10.1053/j.gastro.2006.01.035 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16697726 }} </ref> | ||
HDV genotyping is not indicated in | |||
===Coinfection with HIV and HCV=== | ===Coinfection with HIV and HCV=== | ||
Patients infected with the [[HDV]] should be [[screening|screened]] for concomitant infection with [[HIV]] and [[HCV ]].<ref name="pmid18098143">{{cite journal| author=Cross TJ, Rizzi P, Horner M, Jolly A, Hussain MJ, Smith HM et al.| title=The increasing prevalence of hepatitis delta virus (HDV) infection in South London. | journal=J Med Virol | year= 2008 | volume= 80 | issue= 2 | pages= 277-82 | pmid=18098143 | doi=10.1002/jmv.21078 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18098143 }} </ref><ref name="pmid19566789">{{cite journal| author=Heidrich B, Deterding K, Tillmann HL, Raupach R, Manns MP, Wedemeyer H| title=Virological and clinical characteristics of delta hepatitis in Central Europe. | journal=J Viral Hepat | year= 2009 | volume= 16 | issue= 12 | pages= 883-94 | pmid=19566789 | doi=10.1111/j.1365-2893.2009.01144.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19566789 }} </ref><ref name="pmid19566789">{{cite journal| author=Heidrich B, Deterding K, Tillmann HL, Raupach R, Manns MP, Wedemeyer H| title=Virological and clinical characteristics of delta hepatitis in Central Europe. | journal=J Viral Hepat | year= 2009 | volume= 16 | issue= 12 | pages= 883-94 | pmid=19566789 | doi=10.1111/j.1365-2893.2009.01144.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19566789 }} </ref> | Patients infected with the [[HDV]] should be [[screening|screened]] for concomitant infection with [[HIV]] and [[HCV ]].<ref name="pmid18098143">{{cite journal| author=Cross TJ, Rizzi P, Horner M, Jolly A, Hussain MJ, Smith HM et al.| title=The increasing prevalence of hepatitis delta virus (HDV) infection in South London. | journal=J Med Virol | year= 2008 | volume= 80 | issue= 2 | pages= 277-82 | pmid=18098143 | doi=10.1002/jmv.21078 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18098143 }} </ref><ref name="pmid19566789">{{cite journal| author=Heidrich B, Deterding K, Tillmann HL, Raupach R, Manns MP, Wedemeyer H| title=Virological and clinical characteristics of delta hepatitis in Central Europe. | journal=J Viral Hepat | year= 2009 | volume= 16 | issue= 12 | pages= 883-94 | pmid=19566789 | doi=10.1111/j.1365-2893.2009.01144.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19566789 }} </ref><ref name="pmid19566789">{{cite journal| author=Heidrich B, Deterding K, Tillmann HL, Raupach R, Manns MP, Wedemeyer H| title=Virological and clinical characteristics of delta hepatitis in Central Europe. | journal=J Viral Hepat | year= 2009 | volume= 16 | issue= 12 | pages= 883-94 | pmid=19566789 | doi=10.1111/j.1365-2893.2009.01144.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19566789 }} </ref> | ||
The table below describes the significance of diagnostic markers in HDV infection. <ref name="pmid21511329">{{cite journal| author=Hughes SA, Wedemeyer H, Harrison PM| title=Hepatitis delta virus. | journal=Lancet | year= 2011 | volume= 378 | issue= 9785 | pages= 73-85 | pmid=21511329 | doi=10.1016/S0140-6736(10)61931-9 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21511329 }} </ref> | The table below describes the significance of diagnostic markers in [[HDV infection]]. <ref name="pmid21511329">{{cite journal| author=Hughes SA, Wedemeyer H, Harrison PM| title=Hepatitis delta virus. | journal=Lancet | year= 2011 | volume= 378 | issue= 9785 | pages= 73-85 | pmid=21511329 | doi=10.1016/S0140-6736(10)61931-9 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21511329 }} </ref> | ||
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Revision as of 03:46, 8 August 2014
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Hepatitis D |
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Diagnosis |
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Treatment |
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Hepatitis D laboratory findings On the Web |
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American Roentgen Ray Society Images of Hepatitis D laboratory findings |
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Risk calculators and risk factors for Hepatitis D laboratory findings |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jolanta Marszalek, M.D. [2] João André Alves Silva, M.D. [3]
Overview
Laboratory Findings
Hepatitis D should be considered in any individual who is HBsAg positive or that has evidence of recent HBV infection. The diagnosis of acute hepatitis D is made after evaluation of serologic tests for the virus. Persons infected with HDV develop anti-HDV antibodies. Accordingly, every individual with an HBsAg positive test result, should be studied for the presence of anti-HDV IgG antibodies.[1] These antibodies usually persist in circulation, however they may become negative in some patients.
The active form of the HDV infection was initially diagnosed by the detection of anti-HDV IgM antibodies. However, today the acute infection is confirmed with real-time PCR, by detecting serum HDV RNA.[2]
Patients presenting with liver disease, following HDV infection, should be tested for anti-HDV IgM antibodies, even when the HDV RNA test is negative. This is due to the fact that the hepatitis D virus shows genome variability, which might lead to false-negative results.[3][4] Although the levels of HDV RNA in the serum do not correlate with the stage of the disease, or liver fibrosis, the HDV RNA quantification may be used to evaluate the response to the antiviral therapy.[5]
Genotyping
The use of genotyping as a diagnostic test is gaining acceptance among different countries, due to the association of HDV genotype 1 to a higher degree of liver disease and to a worst response to treatment with pegylated IFN.[6]
HDV genotyping is not indicated in
Coinfection with HIV and HCV
Patients infected with the HDV should be screened for concomitant infection with HIV and HCV .[7][8][8]
The table below describes the significance of diagnostic markers in HDV infection. [1]
| Diagnostic Markers | Significance |
|---|---|
| Anti-HDV IgG antibody |
|
| Anti-HDV IgM antibody |
|
| HDV RNA |
Qualitative
Quantitative
|
| HBsAg |
Qualitative
Quantitative
|
| HBeAg |
|
| HBV DNA |
Quantitative
|
| ALT |
|
According to different studies, it hasn't been noted an association between HDV RNA levels, HBsAg titre, liver test results and the stage of liver disease. Therefore, liver biopsy remains an important tool to assess pathological changes in liver histology.[1]
Below is a diagram representing the assessment of patients with hepatitis D:
References
- ↑ 1.0 1.1 1.2 Hughes SA, Wedemeyer H, Harrison PM (2011). "Hepatitis delta virus". Lancet. 378 (9785): 73–85. doi:10.1016/S0140-6736(10)61931-9. PMID 21511329.
- ↑ Mederacke I, Bremer B, Heidrich B, Kirschner J, Deterding K, Bock T; et al. (2010). "Establishment of a novel quantitative hepatitis D virus (HDV) RNA assay using the Cobas TaqMan platform to study HDV RNA kinetics". J Clin Microbiol. 48 (6): 2022–9. doi:10.1128/JCM.00084-10. PMC 2884474. PMID 20351206.
- ↑ Manesis EK, Schina M, Le Gal F, Agelopoulou O, Papaioannou C, Kalligeros C; et al. (2007). "Quantitative analysis of hepatitis D virus RNA and hepatitis B surface antigen serum levels in chronic delta hepatitis improves treatment monitoring". Antivir Ther. 12 (3): 381–8. PMID 17591028.
- ↑ Le Gal F, Gordien E, Affolabi D, Hanslik T, Alloui C, Dény P; et al. (2005). "Quantification of hepatitis delta virus RNA in serum by consensus real-time PCR indicates different patterns of virological response to interferon therapy in chronically infected patients". J Clin Microbiol. 43 (5): 2363–9. doi:10.1128/JCM.43.5.2363-2369.2005. PMC 1153793. PMID 15872267.
- ↑ Zachou K, Yurdaydin C, Drebber U, Dalekos GN, Erhardt A, Cakaloglu Y; et al. (2010). "Quantitative HBsAg and HDV-RNA levels in chronic delta hepatitis". Liver Int. 30 (3): 430–7. doi:10.1111/j.1478-3231.2009.02140.x. PMID 19840253.
- ↑ Su CW, Huang YH, Huo TI, Shih HH, Sheen IJ, Chen SW; et al. (2006). "Genotypes and viremia of hepatitis B and D viruses are associated with outcomes of chronic hepatitis D patients". Gastroenterology. 130 (6): 1625–35. doi:10.1053/j.gastro.2006.01.035. PMID 16697726.
- ↑ Cross TJ, Rizzi P, Horner M, Jolly A, Hussain MJ, Smith HM; et al. (2008). "The increasing prevalence of hepatitis delta virus (HDV) infection in South London". J Med Virol. 80 (2): 277–82. doi:10.1002/jmv.21078. PMID 18098143.
- ↑ 8.0 8.1 Heidrich B, Deterding K, Tillmann HL, Raupach R, Manns MP, Wedemeyer H (2009). "Virological and clinical characteristics of delta hepatitis in Central Europe". J Viral Hepat. 16 (12): 883–94. doi:10.1111/j.1365-2893.2009.01144.x. PMID 19566789.
- ↑ Heidrich B, Manns MP, Wedemeyer H (2013). "Treatment options for hepatitis delta virus infection". Curr Infect Dis Rep. 15 (1): 31–8. doi:10.1007/s11908-012-0307-z. PMID 23242761.