Two infection scenarios
Coinfection is simultaneous infection with viruses B and D. It occurs as acute hepatitis, sometimes two-wave, often more severe than regular hepatitis B, but in most cases it ends in recovery, because when the B virus is eliminated, the delta virus also disappears. Superinfection is infection with the delta virus of a person who already has chronic hepatitis B. This option is much more dangerous: it manifests itself as a sharp exacerbation, almost always becomes chronic and significantly accelerates the development of fibrosis and cirrhosis. Tests and medical history help distinguish between scenarios.
- Coinfection - simultaneous infection of B and D
- Superinfection - joining D to chronic hepatitis B
- Superinfection almost always becomes chronic
- Rapid progression of liver fibrosis
- Increased risk of cirrhosis and liver cancer
- Without virus B, delta virus cannot exist
How is it transmitted?
The transmission routes are the same as for hepatitis B: through blood and other body fluids. The greatest risk is associated with the sharing of syringes, non-sterile medical and dental instruments, tattooing, piercing and manicure procedures with improper handling of instruments, and previous blood transfusions. Transmission is possible through unprotected sexual contact and from mother to child, although for the delta virus this route is less significant than for hepatitis B. In everyday life, the virus is not transmitted through dishes, hugs and shared food.
- Sharing syringes and injecting drug use
- Non-sterile medical and dental instruments
- Tattoos, piercings, manicures in case of processing violations
- Blood transfusions in the past
- Unprotected sex
- Less often - from mother to child
Symptoms
The acute form manifests itself as a typical viral hepatitis: weakness, nausea, loss of appetite, heaviness in the right hypochondrium, dark urine and jaundice. During superinfection, a person with chronic hepatitis B suddenly feels worse, liver enzymes rise sharply, and jaundice may appear where previously the disease was calm. Chronic delta infection may not produce clear symptoms for a long time, manifesting itself only in fatigue and decreased performance, and is detected already at the stage of severe fibrosis or cirrhosis.
- Weakness and fatigue
- Nausea, loss of appetite
- Heaviness and pain in the right hypochondrium
- Jaundice and dark urine
- A sharp exacerbation in a carrier of hepatitis B
- Signs of cirrhosis during late diagnosis
Diagnostics
The starting point is a positive HBsAg: it makes sense to look for delta infection only in people with hepatitis B, and such testing is recommended for each of them at least once. The main screening test is total anti-HDV antibodies. If the result is positive, the doctor assesses the activity of the infection and prescribes additional tests. Be sure to determine ALT, AST, bilirubin, coagulation parameters, hepatitis B virus DNA, and also evaluate the stage of liver fibrosis using elastography or calculated indices and perform an ultrasound of the liver.
- HBsAg as a starting point for examination
- Total anti-HDV antibodies
- ALT, AST, bilirubin, albumin, coagulogram
- Hepatitis B virus DNA
- Liver elastography to assess fibrosis
- Liver ultrasound and tumor risk monitoring
Treatment and prevention
Treatment of delta infection is more difficult than other hepatitis and is carried out only by a specialist. Interferon drugs are used in long courses, and in a number of countries new drugs are available that block the penetration of the virus into liver cells. At the same time, hepatitis B is controlled and the condition of the liver is monitored. All patients require complete abstinence from alcohol, vaccination against hepatitis A, body weight control and regular monitoring with ultrasound for early detection of the tumor. If cirrhosis develops with complications, liver transplantation is discussed. The best prevention is vaccination against hepatitis B.
- Antiviral therapy as prescribed by a specialist
- Control of hepatitis B and delta virus activity
- Complete abstinence from alcohol
- Regular assessment of fibrosis and liver ultrasound
- Hepatitis B vaccination for prevention
- Discussion of transplantation in decompensated cirrhosis