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Hepatitis delta (sometimes called hepatitis D virus, or HDV) is a bit different to other hepatitis viruses, because it can only affect people who  have hepatitis B. It is a subviral satellite of hepatitis B1, meaning it needs the hepatitis B virus to be present in your body, so it is able to replicate2. Hepatitis delta can accelerate the health impacts of hepatitis B, leading to more severe outcomes for people living with both viruses.

It is estimated approximately 5% of people living with hepatitis B in Australia also have hepatitis delta.3 There is no vaccine to prevent infection with hepatitis delta, but being vaccinated against hepatitis B will also protect anyone who does not already have hepatitis B from contracting hepatitis delta.

How do you get hepatitis delta?

Hepatitis delta is transmitted in the same ways as hepatitis B, by infected blood or body fluids getting into your blood (such as exposure to an open wound or sharing unsterile injecting equipment), or through sex without a condom with a partner who has hepatitis delta. You cannot get hepatitis B or hepatitis delta through saliva or through casual contact such as kissing, hugging or sharing food. Unlike hepatitis B, transmission of hepatitis delta at birth is uncommon4, however transmission can occur through household contact (such as sharing razors or toothbrushes) and hepatitis delta is known to cluster in families.

You can get hepatitis delta at the same time as hepatitis B (co-infection) or later after you have developed chronic hepatitis B (superinfection)4.

People who are co-infected with hepatitis delta are more likely to only develop an acute (short-term) hepatitis delta infection, meaning they will clear the virus naturally within six months. While most people with co-infection will clear both viruses on their own, there is a higher risk of developing fulminant hepatitis (acute liver failure), which can be deadly4.

Superinfection is the most common form of hepatitis delta and is more likely to lead to a chronic (life‑long) hepatitis delta infection. If you have chronic hepatitis delta, you have a higher chance of developing cirrhosis (severe scarring of the liver) and liver cancer4,5.

Who is at risk of hepatitis delta?

All people with hepatitis B should be tested for hepatitis delta.3 Testing is done through a blood test (like the tests for hepatitis B and hepatitis C).

Hepatitis delta is more common in certain regions of the world including the Middle East, West and Central Africa and the Amazonian river basin, and some specific countries, including Mongolia, Romania, Russia, Pakistan, Georgia and Turkey.4 However, country or region of birth is not a reliable predictor of hepatitis delta status, which is why universal testing is recommended for everyone with hepatitis B. In Australia, hepatitis delta has been shown to be most common in people born in Vietnam, Sudan, and Afghanistan, as well as there being higher risk for people who have ever been in prison.6 There is no evidence to suggest that hepatitis delta is more common among Aboriginal and Torres Strait Islander people. 6,7

Global prevalence of hepatitis delta among people living with hepatitis B:

Image reference: Hepatitis B Foundation. (n.d.). Hepatitis Delta Connect. Retrieved from Hepatitis B Foundation: www.hepb.org/research-and-programs/hepdeltaconnect/

Symptoms of hepatitis delta

Hepatitis delta symptoms are similar to those of hepatitis B, and many people may not experience symptoms for a long time. Symptoms include4:

  • Fever, fatigue, muscle or joint pain
  • Loss of appetite
  • Nausea and vomiting
  • Stomach pain
  • Pale or light-coloured stools (poo)
  • Dark or brown-coloured urine

Serious symptoms that require immediate medical attention include:

  • Severe nausea and vomiting
  • Yellow eyes and skin (called "jaundice")
  • Bloated or swollen stomach.

Is there treatment for hepatitis delta?

The current antiviral treatments used for hepatitis B are not effective for hepatitis delta. Some people have been successfully treated with pegylated interferon, however for most people there are no approved treatments that are effective against hepatitis delta yet6.

Some new drugs to treat hepatitis delta are currently being tested. If you have hepatitis delta, you may wish to talk to your specialist to see if there are any clinical trials that you can participate in.

Ongoing monitoring is important for anyone with hepatitis B, but especially if you have hepatitis delta, as your risk of liver damage is higher. It is important that your doctor is informed about your hepatitis delta status as it can impact the results of some of your tests.

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More information

What is hepatitis B?

Hepatitis B Liver monitoring video

References

  1. Taylor, J. (2008). Hepatitis Delta Virus. In B. W. Mahy, & M. H. Van Regenmortel, Encyclopedia of Virology (Third Edition) (pp. 375-377). Elsevier.
  2. Department of Health & Human Services. (n.d.). Hepatitis D. Retrieved from health.vic: https://www2.health.vic.gov.au/public-health/infectious-diseases/disease-information-advice/hepatitis-d
  3. ASHM. (n.d.). Complex situations Co-infection and Immunosuppression. Retrieved from B Positive: Hepatitis B for primary care: https://www.hepatitisb.org.au/complex-situations-co-infection-and-immunosuppression/
  4. Hepatitis B Foundation. (n.d.). Hepatitis Delta Connect. Retrieved from Hepatitis B Foundation: https://www.hepb.org/research-and-programs/hepdeltaconnect/
  5. SA Health. (n.d.). Hepatitis D - including symptoms, treatment and prevention. Retrieved from SA Health: https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/conditions/infectious+diseases/hepatitis/hepatitis+d+-+including+symptoms+treatment+and+prevention
  1. Jackson, K., MacLachlan, J., Cowie, B., Locarnini, S., Bowden, S., Higgins, N., . . . Littlejohn, M. (2018). Epidemiology and phylogenetic analysis of hepatitis D virus infection in Australia. Internal Medicine Journal, 1308-1317.
  2. Coghill, S., Mcnamara, J., Woods, M., & Hajkowicz, K. (2018). Epidemiology and clinical outcomes of hepatitis delta (D) virus infection in Queensland, Australia. International Journal of Infectious Diseases, 123-127.

Page Updated: 25 February 2021