Hepatitis D natural history
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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]
Overview
Natural History
With HBV and HDV co-infection, the fate of HDV is determined by the hosts reponse to HBV. In more than 95% of adults, HDV is cleared. Acute co-infection can be more sever than acute monoinfection 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.
The onset of symptoms of hepatitis D - similar to those of hepatitis B - is usually abrupt. As in other forms of hepatitis, jaundice usually develops after the disappearance of symptoms reflecting the initial acute infection. When a person is infected concurrently with hepatitis B and D, fulminant hepatitis is much more likely to occur than with infection with only hepatitis B, and some persons with fulminant hepatitis will die. In addition, patients with hepatitis D superinfection are more likely to progress to chronic liver disease than those patients with HBV infection alone.[1]
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.[2]
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.
- ↑ 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.