What is hepatitis D?

You can only have hepatitis D if you have hepatitis B. It can make your liver disease worse.
Other names for hepatitis D are Hepatitis Delta or HDV.
Everyone with hepatitis B should get tested for hepatitis D at least once.
If you have hepatitis D you should get regular check-ups with a specialist liver doctor.

Hepatitis D is a serious health condition, but there are things you can do to live well. There is support available.

Hepatitis D is a virus that affects the liver. You can only get it if you also have hepatitis B. This is because the hepatitis D virus needs the hepatitis B virus to survive in the body. Hepatitis D can be found all around the world, but it’s more common in some regions than others. Hepatitis D is not common in Australia.

Transmission

Sometimes you can get infected with hepatitis B and D at the same time. This is called a co-infection. If you have hepatitis B for a long time and then get infected with hepatitis D, that is called a superinfection. You can read more about it in our FAQ - "Will I have hepatitis D for life?".

Learn more about transmission

Liver disease

When someone has both hepatitis B and hepatitis D, it can make the liver illness more serious. Over time, this can lead to long-term liver problems, such as scarring of the liver (cirrhosis), liver failure or liver cancer.

Learn more about symptoms

Prevention

Hepatitis D can be prevented by getting the hepatitis B vaccine. But if you already have hepatitis B, there’s no vaccine that can prevent hepatitis D. But there is medicine that can help if you get hepatitis D.

Testing and treatment

For people who already have hepatitis B, testing can help detect hepatitis D early. If you have hepatitis D, regular check-ups are important, and treatments are available to help manage the infection and protect the liver.

Learn more about testing

Learn more about what to do after diagnosis

Get support

If you have questions about hepatitis D, you can call HepLink for free on 1800 437 222. It is free to call, and you do not need a Medicare card.

Learn more about HepLink

This page was developed with grant funding from Gilead Sciences.

How do people get hepatitis D?

Hepatitis D is only spread through infected blood-to-blood contact
It can not spread through casual contact, like hugging, kissing or sharing food
It is common for hepatitis D to spread between family members.

Ways to get hepatitis D

People can get hepatitis D if the virus enters their bloodstream through infected blood.

Some of the ways this can happen are:

by sharing needles, syringes or other injecting equipment, including spoons
tattooing or body piercing with unsterile equipment
medical procedures with unsterile equipment
sharing toothbrushes, razors or nail files
having cuts or sores that are uncovered.

Many people with hepatitis D have never injected drugs, had tattoos, or been exposed to other “typical” risk factors. For many, it’s not clear exactly how they got the virus.

If you’re concerned about your risk or want advice, you can reach out to HepLink at 1800 437 222 for support and information.

You cannot get hepatitis D through:

hugging or kissing
sharing food and eating utensils
eating food made by someone with hepatitis D
insect or animal bites, including mosquitoes
sharing bathrooms, showers or toilets
spitting (saliva)
sneezing or coughing.

Family and pregnancy

Hepatitis D can sometimes be passed between family members or people living in the same household. This happens through contact with infected blood, such as cuts or sores. It does not happen through casual contact like hugging, sharing food, or playing together.

Pregnancy

It is unlikely for hepatitis D to pass from mother to child during pregnancy. However, your baby can get hepatitis B at birth.

You can read more about how to protect your baby from getting hepatitis B here. If you vaccinate your baby for hepatitis B, they cannot get hepatitis D.

You should speak to your doctor if you are pregnant and have hepatitis D.

This page was developed with grant funding from Gilead Sciences.

Who is more likely to get hepatitis D?

You can only get hepatitis D if you already have hepatitis B, or get infected by both viruses at the same time. If you have hepatitis B, you should get tested for hepatitis D. You can do this with a blood test through your doctor.

If you need help to find a doctor, you can call HepLink on 1800 437 222.

Some parts of the world have higher hepatitis D rates. But hepatitis D is rare in Australia.

You're also more likely to get hepatitis D if you have ever been in prison.

This page was developed with grant funding from Gilead Sciences.

Hepatitis D Symptoms

Some people can have hepatitis D but feel fine.
Hepatitis D can badly damage your liver, and lead to serious liver scarring (cirrhosis) liver failure, and liver cancer.
If you have hepatitis D, you should regularly see your doctor. They will monitor your liver to see that it doesn't get worse.
You can only know if you have hepatitis D by taking a blood test.

Everyone with hepatitis D is different. Some people may feel very sick, while others feel okay. Even if you feel well, it is important to know what is really happening. This is because hepatitis D can damage your liver, even if you don’t feel any symptoms. It is a good idea to go to your doctor if you have hepatitis D.

By visiting your doctor regularly, you can reduce the risks of liver damage.

The symptoms of hepatitis D can be mild to severe, and can include:

Fever, feeling tired, muscle or joint pain
Not feeling hungry
Feeling sick in your stomach and vomiting
Stomach pain
Pale or light-coloured poo
Dark or brown urine (wee)

The symptoms below are serious. If you have any of the below symptoms, you need to go to the doctor right away:

Confusion (encephalopathy)
Yellow eyes and skin (called "jaundice")
Bloated or swollen stomach

Even if your symptoms are mild, it is important to see a doctor.

Some of the things that can happen to your liver over time are:

liver scarring(we call this fibrosis). This means your liver becomes hard and does not work as well
cirrhosis (severe liver scarring) from ongoing liver damage. This can lead to the liver not working well
liver failure, which means your liver stops working
liver cancer. You can get liver cancer even if you feel healthy.

The only way to know if you have hepatitis D is to get a blood test through your doctor. Talk to your doctor if you have hepatitis B about testing for hepatitis D.

If you have hepatitis D, it is important to keep seeing your doctor to reduce the risks of liver damage. You should do this even if you don’t have any signs of illness.

This page was developed with grant funding from Gilead Sciences.

Testing and talking to your doctor

If you have hepatitis B, it is important to get tested for hepatitis D at least once.
You need to ask for a hepatitis D blood test.
You can get an interpreter for your appointment

The only way to know if you have hepatitis D is through a blood test. The hepatitis D test isn’t part of a standard blood test, so you’ll need to ask your doctor for a hepatitis D test.

You can ask for an interpreter at your appointment. They can help you understand what your doctor or nurse is saying. Even if you understand some English, you can still ask for an interpreter. It is important that you understand what is happening with your health.

This is how testing for hepatitis D works:

You will first get a hepatitis D antibody test. This will check if you have ever had hepatitis D. This test is covered by Medicare.
If the first test is positive, you will have another test. This test will check if you currently have hepatitis D. This test is not covered by Medicare.

If you don’t have a regular doctor or aren’t sure where to go, you can call HepLink at 1800 437 222 for free and confidential help. They can connect you with local services and doctors who can test you and give you care.

Talking to your doctor

It can be hard to know what to ask your doctor when you want to get tested for hepatitis D.

Here are some questions you can ask your hepatitis B doctor. If you don’t have a specific doctor for your hepatitis D, you can ask your normal doctor.

Ask: Have I been tested for hepatitis D?
If the answer is no: You should tell them you would like to get tested.
If the answer is yes: Ask your doctor about your results
If your test is negative: Ask your doctor if you need to get tested again
If your test is positive: Ask your doctor what you should do next. If your doctor does not give you a referral to a specialist, you can ask for that too. A specialist will be able to provide the care that you need.

What to do after diagnosis?

See a specialist doctor who is an expert on hepatitis
You will need to do some tests to see how well your liver is doing
You may need to take medicine to keep your liver healthy. Some medicines can cure hepatitis D.
Life-style changes, such as not smoking or drinking alcohol, can keep your liver healthy for longer.

Because hepatitis D is linked to hepatitis B and both viruses affect your liver, a lot of the management is the same. However, because hepatitis D can make liver disease worse, it is very important that you get the right care.

This page explains what you will need to do to manage hepatitis D.

See a specialist doctor

If you have hepatitis D, you will need to see a specialist liver doctor. If you don’t already have a specialist doctor, your doctor can refer you to see one. If your doctor doesn’t give you a referral, you can ask for one.

The types of specialists you can see for hepatitis D are Gastroenterologists, Hepatologists or Infectious Diseases specialists.

You don’t always get to choose the specialist. It depends who is in your area and how soon they can see you.

If you need help to find a specialist, you or your doctor can contact HepLink on 1800 437 222.

Monitoring

When you are first diagnosed with hepatitis D, you will be offered a liver ultrasound and a liver FibroScan. The FibroScan looks for scarring on your liver (cirrhosis), and the ultrasound looks for liver cancer. You may also have a blood test to look at your hepatitis D virus levels. You may need a blood test every 3-6 months, and a FibroScan every 1-2 years.

You will likely also need a liver biopsy. This helps the specialist see how much scarring or liver damage there is. A liver biopsy is done with a local anaesthetic by a radiologist. This will prevent you from feeling pain.

People with hepatitis D will need regular tests to check their liver every 6 months. The tests will be for both hepatitis B and hepatitis D at the same time.

If you have developed cirrhosis, you may need to see your specialist every 3 months instead.

Costs

Public specialists are free if you have Medicare.

Going to a private specialist will cost money. You may also need to pay for the cost of some tests. Ultrasounds are covered by Medicare.

You can ask the specialist about their fees before you go to the appointment.

If you need help to find a specialist that you can afford, you can contact HepLink on 1800 437 222. You can also contact HepLink if you are worried about costs.

Medicines

People with hepatitis D will get medicine for hepatitis B. This protects their liver and reduces liver damage.

Some medicines available in Australia can help treat hepatitis D. One is on the Pharmaceutical Benefits Scheme (PBS). It can cure some people and help slow down damage to your liver. Another has been approved in Australia but is not on the PBS, so it’s harder to access and more expensive.

Pegylated interferon alpha

Some people have used a medicine called pegylated interferon alpha. It is a weekly injection, usually for 48 weeks. In some people, this medicine has cleared the virus. But this can only happen in people whose livers are still working well.

This medicine can have good results even if it doesn’t cure you. It can help slow down the damage to your liver, keeping it healthier for longer.

Bulevirtide

Bulevirtide is another medicine approved to treat hepatitis D in Australia, but it is not yet on the PBS. It has been shown to be very successful at treating hepatitis D, with lower risks of side effects. Because it is not on the PBS, the medicine is expensive.

Hepatitis Australia and its members have asked the government to make Bulevirtide available on the PBS.

Researchers are testing some new medicines for hepatitis D. If you have hepatitis D, you can talk to your doctor to see if there are any clinical trials you can take part in or call HepLink on 1800 437 222.

Looking after your liver

Alcohol, cigarettes and being overweight can damage your liver. This can make you more sick because hepatitis D also damages your liver.

There are things you can do in your daily routine to take care of your liver as well as visiting your doctor:

Eating a balanced diet with lots of vegetables.
Try to be active most days. Aim for about 30 minutes of movement that gets your heart rate up but still lets you talk, like walking fast
Avoid or reduce alcohol, smoking and other drugs. If you need help to do this you can speak to your doctor or use one of these support services:
- Drinking less alcohol or using less drugs: adf.org.au/help-support/
- Quit smoking (Quitline): 13 78 48

This page was developed with grant funding from Gilead Sciences.

Get support

You don’t have to manage hepatitis D alone. Support, information, and care are available across Australia.

HepLink Australia

HepLink Australia provides confidential, free and localised information and support for hepatitis B, C and D. You can call them on 1800 437 222 or visit their website.

It is free to call, and you do not need a Medicare card.

When you contact HepLink, you will be connected with an expert on hepatitis. They can answer your questions about hepatitis and help you find services near you, like a doctor or support programs.

If you need an interpreter, please call TIS National on 131 450 and ask them to call HepLink Australia on 1800 437 222. TIS National can support in over 150 languages. See the list of languages here.

Learn more about HepLink

This page was developed with grant funding from Gilead Sciences.

For health professionals

Australian Guidelines recommend that everyone who has been diagnosed with hepatitis B should get tested for hepatitis D at least once.

Hepatitis D is less common than hepatitis B, but it can cause serious liver disease, including cirrhosis and liver failure. Early identification and management are important to improve outcomes.

These clinical resources provide information for doctors about testing for hepatitis D:

HepLink

HepLink is available to support health professionals with in-consultation support, referrals and linkage. Call 1800 437 222 or visit www.heplink.au.

Many people living with hepatitis D may require information in languages other than English. HepLink has a TIS National account, and patients can call TIS National on 131 450 and ask them to call HepLink Australia on 1800 437 222.

Learn more how HepLink can support health professionals

This page was developed with grant funding from Gilead Sciences.

FAQ

Some medicines available in Australia can help treat hepatitis D.

Pegylated interferon alpha is on the Pharmaceutical Benefits Scheme (PBS), and can cure some people. This can only happen in people whose livers are still working well. This medicine can have good results even if it doesn’t cure you. It can help slow down the damage to your liver, keeping it healthier for longer.

Bulevirtide has been approved in Australia but is not yet on the PBS, so it’s harder to access. It has been shown to be effective at treating hepatitis D, with lower risks of side effects. Because it is not on the PBS, the medicine might be expensive.

If you have hepatitis D, you can talk to your doctor to see if there are any clinical trials you can take part in or call HepLink on 1800 437 222.

Having hepatitis D doesn’t mean you will die from it. Many people live a long life with good liver health when they have regular medical care and make healthy lifestyle choices. Seeing your doctor regularly helps catch any changes early so you can get the right care.

Some people who get hepatitis D will only get it for a short time (less than 6 months). If you have it for more than 6 months, it will be long-term and you will likely have it for your whole life.

Hepatitis D can be prevented by getting the hepatitis B vaccine. But if you already have hepatitis B, there’s no vaccine that can prevent hepatitis D.

The best way to prevent hepatitis D from getting worse is to visit your doctor regularly. Staying healthy by exercising regularly, eating a balanced diet and avoiding alcohol, smoking and other drugs is also good for your liver.

The best protection against hepatitis D is to get vaccinated against hepatitis B.

You can follow good blood safety by making sure your blood doesn’t touch anyone else’s blood, for example by:
- not sharing razors or toothbrushes
- not sharing any needles or injecting equipment
- covering any wounds.

Remember, you cannot get hepatitis D through casual contact including hugging, kissing or sharing food.

We don’t know for sure if hepatitis D can be passed on through sex. Hepatitis D spreads through blood-to-blood contact, so it may be possible if there is any bleeding during sex.

The amount of blood needed to pass hepatitis D may be so small you can’t even see it. You may be more likely to get hepatitis D if you:

have anal sex without a condom
engage in fisting
have sex while you or your partner is on their period
have sex and have cuts or sores near your genital area
engage in rough sex practices that could lead to bleeding
share sex toys that are not clean
have sex while using drugs through a needle or snorted
share lube pots that could transfer blood

If your partner is not vaccinated against hepatitis B, it is a good idea to use condoms. This is because hepatitis B can be spread through sexual fluids. Protecting against hepatitis B will help protect against hepatitis D.

No, you cannot get hepatitis D by sharing food and utensils. You can only get hepatitis D from infected blood.

It is unlikely that hepatitis D will spread from mother to child during pregnancy or birth. However, your baby can get hepatitis B during birth.

Vaccine for baby

Most babies born in Australia have a hepatitis B vaccine as soon as they are born. We call this the birth dose. If you are pregnant and have hepatitis B, your baby should have an extra injection within 12 hours of birth. This injection gives your baby extra protection to help stop them from getting hepatitis B. They will also get three more hepatitis B vaccines over the next 6 months like other babies. Together this works well to protect the baby against the virus.

Your baby will have a blood test when they are about nine to 12 months old. This test checks for infection and immunity. If your baby is vaccinated against hepatitis B, it cannot get hepatitis D.

Medicine for pregnant women

Some women have a high level of the virus in their body while they are pregnant. This means they are more likely to pass it on to their baby. If you have a high level of hepatitis B your doctor can give you an antiviral medicine. You'll take this during the third trimester and up to a few weeks after birth. This will make it very unlikely that you pass the virus onto your baby. Talk to your doctor about this. They may suggest you keep taking the medicine, stop, or swap to another medicine.

No. Hepatitis D does not spread through touching or saliva. You can only get hepatitis D from infected blood.

There are two types of hepatitis D infections: Superinfections and co-infections.

A hepatitis D co-infection happens when a person gets infected by hepatitis B and hepatitis D at the same time. If you are co-infected with hepatitis D, you are more likely to only have short-term hepatitis D. This means you will have it for less than 6 months. However, there is also a chance that co-infections develop into long-term (chronic) hepatitis D. This is why it is important to monitor the infection until your doctor says it's gone.

A hepatitis D superinfection happens when someone who already has a long-term hepatitis B infection gets infected with hepatitis D. Superinfection is the most common form of hepatitis D. If you have this, you're more likely to have hepatitis D for your whole life.

Yes, you should get your liver checked at least every 6 months. Even if you feel fine, hepatitis D can still damage your liver. If you wait until you feel sick, you might already have liver damage that can't be fixed. The only way to know this is to keep getting your liver checked. If the virus starts causing damage to your liver, you can take medicine. The medicine can slow down the damage and make you less likely to get liver disease, such as fibrosis or cirrhosis, or liver cancer.

Most of the time it is your choice whether or not to tell people if you have hepatitis D.

You don't have to tell other doctors, dentists, or people who work in tattoo and piercing parlours. This is because these places have rules in place to stop the spread of viruses. The rules are the same for everyone, regardless of whether they know if you have hepatitis B.

It's a good idea to tell your partner, family and people you live with. This means they can get tested for hepatitis B and hepatitis D. If they don't have it, they can protect themselves by getting a hepatitis B vaccine.

Sometimes you must tell people that you have hepatitis D and B. There are also some situations where you will be tested for hepatitis B:

before giving blood. You can't give blood if you have hepatitis D or B. The Australian Red Cross Blood Service (“Lifeblood”) will test your blood for hepatitis B.
when applying for some kinds of insurance. For a full list of insurances, visit who do you have to tell
if you are applying for the Australian Defence Force, including Navy, Army and Air Forces. If you apply to join the Australian Defence Force, you must tell them you have hepatitis B. You will also get tested for hepatitis B.
if you are a healthcare worker who carries out exposure-prone procedures (EPPs). An EPP is when you work with sharp instruments or exposed tissues, such as bone or teeth, and you can’t always see your hands or fingers inside the patient’s body. Most often this applies to surgeons and dentists. Most healthcare workers do not do EPPs. You can learn more about EPPs on the AusMed website.
when applying for a visa to live in Australia. Everything you say in your application form must be true. Sometimes you may need to have a hepatitis B test if you are applying to live in Australia, although for most people it won’t affect your visa. Read the Visa and Migration FAQ for more information.
If you wish to donate sperm. They will test you for hepatitis B before you can donate. You cannot donate if you test positive for hepatitis B. The only time you can is when it's for you and your partner.
If you wish to donate organs. Organs are checked to see if they are okay for transplantation. You might not be able to donate if you have hepatitis D.

Yes. It's your choice who you tell that you have hepatitis D. It's a good idea to tell your partner, family and the people you live with. This means they can get tested. If they have never had hepatitis B they can protect themselves from hepatitis D by getting the hepatitis B vaccine. If you vaccinate against hepatitis B, that will stop both hepatitis B and hepatitis D.

If you are taking antiviral treatment for hepatitis B, some herbal medicines can interact with the antiviral medicines. This can can be dangerous.

Remember that alternative medicines do not replace a healthy lifestyle. If you have hepatitis D it is important to eat healthy, exercise and avoid alcohol and tobacco.

Always check with your specialist before taking any alternative medicines. There is no evidence that alternative medicines (including herbal medicines and Traditional Chinese Medicine) can cure or treat hepatitis D.

Hepatitis D is a virus that can only exist in the body if it already has the hepatitis B virus. Hepatitis D can make hepatitis B worse, and has a higher chance of causing liver damage. There is no vaccine for hepatitis D, but if can be prevented if you are vaccinated against hepatitis B. There are some medicines available that have had success with curing hepatitis D.

Testing for hepatitis D is not a part of normal blood test. Most of the time you have to ask your doctor.

This page was developed with grant funding from Gilead Sciences.

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Hepatitis D

ON THIS PAGE

Hepatitis D

What is hepatitis D?

How do people get hepatitis D?

On this page:

Ways to get hepatitis D

Family and pregnancy

Who is more likely to get hepatitis D?

Hepatitis D Symptoms

Testing and talking to your doctor

Talking to your doctor

What to do after diagnosis?

On this page:

See a specialist doctor

Monitoring

Costs

Medicines

Looking after your liver

Get support

HepLink Australia

For health professionals

HepLink

FAQ

Is there a cure for hepatitis D?

Will I die from hepatitis D?

Can hepatitis D get better on its own?

Is there a vaccine for hepatitis D?

Can I prevent hepatitis D from getting worse?

Can I protect my family and friends from getting hepatitis D?

Can I get hepatitis D through sex?

Can I get hepatitis D from sharing food or eating utensils?

I’m pregnant and have hepatitis D – can my baby get it?

Can I get hepatitis D through hugging or kissing?

Will I have hepatitis D for life?

I have hepatitis D but I feel fine. Do I really need to get regular liver checks?

Do I need to tell anyone if I have hepatitis D?

If I have hepatitis D, should my family get tested?

Is it safe to take herbal medicines or traditional Chinese medicines if I have hepatitis D?

What is the difference between hepatitis B and hepatitis D?

I've had a blood test, have I been tested for hepatitis D?

ON THIS PAGE

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