Hepatitis D natural history: Difference between revisions
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===Hepatocellular Carcinoma=== | ===Hepatocellular Carcinoma=== | ||
*[[Hepatocellular carcinoma]] (HCC) occurs in chronically infected [[HDV]] patients with advanced [[liver disease]] with the same frequency as in patients with [[hepatitis B]]. | *[[Hepatocellular carcinoma]] (HCC) occurs in chronically infected [[HDV]] patients with advanced [[liver disease]] with the same frequency as in patients with [[hepatitis B]].<ref name=WHO>{{cite web | title = Hepatitis D Prevention and treatment | url = http://www.who.int/csr/disease/hepatitis/whocdscsrncs20011/en/index5.html }}</ref> | ||
*[[HCC]] may actually be more a secondary effect of the associated [[cirrhosis]] than a direct [[carcinogenic]] effect of the [[HDV|virus]]. | *[[HCC]] may actually be more a secondary effect of the associated [[cirrhosis]] than a direct [[carcinogenic]] effect of the [[HDV|virus]].<ref name=WHO>{{cite web | title = Hepatitis D Prevention and treatment | url = http://www.who.int/csr/disease/hepatitis/whocdscsrncs20011/en/index5.html }}</ref> | ||
==Prognosis== | ==Prognosis== | ||
Acute hepatitis D is usually resolved within 2 to 3 weeks, with [[liver enzyme]] levels returning to normal in a period of 16 weeks. However, about 10% of infected patients may develop the chronic form of the disease. | |||
The [[mortality rate]] for [[HDV]] infections lies between 2% and 20%, values that are ten times higher than for [[hepatitis B]]. | |||
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. | 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.<ref>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.</ref> | 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.<ref>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.</ref> | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 22:08, 16 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]; Jolanta Marszalek, M.D. [3]; João André Alves Silva, M.D. [4]
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 period of 3-7 weeks, the preicteric phase of acute HDV infection 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. In patients with acute, self-limiting infection, convalescence begins with the disappearance of clinical symptoms. [1]
Fulminant viral hepatitis is rare, however, its mortality rate may reach 80%, and it is about 10 times more common in hepatitis D than in other types of viral hepatitis. It is characterized by:[1][2]
- Hepatic encephalopathy showing changes in personality
- Sleep disturbances
- Confusion
- Concentration difficulties
- Abnormal behavior
- Somnolence
- Coma
About 60 to 70% of patients with chronic hepatitis D develop cirrhosis. Progression to cirrhosis usually takes 5 - 10 yrs, but it can appear 2 years after onset of infection. Many of these patients die of hepatic failure.[1][3]
Coinfection
Coinfection 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. The host's response to HBV determines the fate of HDV. In more than 95% of adults, HDV is cleared, whereas the chronic form occurs in less than 5% of co-infected patients. Although the disease presentation may differ greatly among patients, acute coinfection of HBV and HDV can result in a more severe disease state than acute mono-infection with HBV.[4][5]
Superinfection
HBV and HDV superinfection (HDV infection of a chronically infected HBV carrier) frequently causes a severe acute hepatitis with a short incubation time. In the majority of cases, this leads to chronic type D hepatitis. Superinfection is associated with fulminant hepatitis and severe chronic active hepatitis, often progressing to cirrhosis. 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.[4]
Complications
Common complications of hepatitis D include:
- Chronic active hepatitis
- Fulminant hepatitis
- Hepatic cirrhosis
- Hepatic failure
- Hepatocellular carcinoma
Hepatocellular Carcinoma
- Hepatocellular carcinoma (HCC) occurs in chronically infected HDV patients with advanced liver disease with the same frequency as in patients with hepatitis B.[1]
- HCC may actually be more a secondary effect of the associated cirrhosis than a direct carcinogenic effect of the virus.[1]
Prognosis
Acute hepatitis D is usually resolved within 2 to 3 weeks, with liver enzyme levels returning to normal in a period of 16 weeks. However, about 10% of infected patients may develop the chronic form of the disease.
The mortality rate for HDV infections lies between 2% and 20%, values that are ten times higher than for hepatitis B.
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.[6]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 World Health Organization. Department of Communicable Disease Surveillance. Hepatitis Delta 2001. http://www.who.int/csr/disease/hepatitis/HepatitisD_whocdscsrncs2001_1.pdf
- ↑ Fields, Bernard (2013). Fields virology. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 1451105630.
- ↑ Fields, Bernard (2013). Fields virology. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 1451105630.
- ↑ 4.0 4.1 World Health Organization. Department of Communicable Disease Surveillance. Hepatitis Delta 2001. http://www.who.int/csr/disease/hepatitis/HepatitisD_whocdscsrncs2001_1.pdf
- ↑ 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.
- ↑ 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.