Hepatitis D virus: Causes, symptoms, diagnosis

The article was professionally consulted by MSc Vu Tan Phuc - Gastroenterologist - Department of Medical Examination & Internal Medicine, Vinmec Phu Quoc International General Hospital.

The patient contracted hepatitis D due to infection with the hepatitis D virus (Hepatitis D virus: HDV). According to research, HDV possesses an RNA genome, this structure is not related to hepatitis B virus (HBV), hepatitis A virus (HAV) or hepatitis C virus (HCV).
HDV was first discovered in 1977, HDV creates a combined viral infection in the patient's body, requiring the support of HBsAg surface antigens of HBV virus particles to carry out replication. and rapidly infect other liver cells. The clinical course of patients infected with HDV is quite diverse and can vary rapidly from acute HDV infection, to acute and self-limiting acute liver failure, to fulminant liver failure. Patients diagnosed with chronic HDV infection can rapidly lead to end-stage liver disease and associated complications.

Here are the main causes of hepatitis D:
HDV can be transmitted from person to person by blood, or by direct contact with infected body fluids such as urine. , blood, semen, vaginal fluid. Because the patient received a blood transfusion from someone with hepatitis D. Injecting drug use and sharing needles. Sex is male homosexual. Patients will only be infected with hepatitis D when they are already infected with hepatitis B. This shows that it is completely possible for you to be infected with hepatitis B and D at the same time. According to statistics, about 5% of people infected with hepatitis B will later become infected with hepatitis D.

3.1 Typical symptoms In general, patients with hepatitis D often have no specific symptoms, and clinical symptoms of hepatitis D cannot be distinguished from those of other viral hepatitis. Therefore, the incubation period of HDV is defined as 21-45 days, however the time can be shortened if superinfection from HBV occurs.
Here are the basic signs and symptoms that may occur during the incubation period of hepatitis D:
Dark urine Frequent abdominal pain Jaundice Feeling nauseous or vomiting Body bruising or discharge bleeding (but very rarely) There is an itching sensation.

If a patient begins to have a flare-up of hepatitis D, they will often experience prominent signs and symptoms such as:
Body high fever Jaundice Abdominal pain, often pain in the right corner of the epigastrium Urine dark color Brain disease is encountered (very rare) In addition, it is necessary to differentiate between hepatitis D and some conditions such as:
Drug-induced hepatitis Acetaminophen poisoning Patient has fatty liver in the Pregnancy Hepatic damage due to ischemia Excessive narrowing of the bile duct HELLP syndrome (including elevated liver enzymes, hemolysis, low urine output) caused by pregnancy toxicity Biliary obstruction Hepatotoxicity by Isoniazid.

3.2 Required Tests The following serological tests are commonly used to accurately diagnose HBV and HDV coinfection:
Confirmatory positive test results for HDVAg antigens are approximately 20%. Results showing that patients are positive for HDV-RNA will indicate that the majority of cases have been infected with HDV: of which reverse transcriptase polymerase chain reaction RT-PCR is now a sensitive test. help detect HDV in the blood. Anti-HDV immunoglobulin M (IgM) antibodies will usually test positive during the acute phase and then the patient will test positive for anti-HDV immunoglobulin G (IgG) during chronic HDV infection. The detection of antibodies against HDV A antigens is almost exclusively associated with chronic HDV infections. Hepatitis B surface antigen (HBsAg) is really needed to check for HDV replication in the patient's body. But in many cases they can also be suppressed to the point where we cannot detect duplication of active HDV.

Patients infected with HDV may be prescribed drug therapy. In particular, Pegylated interferon alpha is effective to reduce viral load and the effects of this disease on liver function during the time the drug is being used, but this effect will stop if the drug does not work. used. Statistics show that the effectiveness of treatment with pegylated interferon usually cannot exceed 20%.
Myrcludex B, a drug that has been shown to inhibit viral entry into liver cells, is currently in clinical trials.

Currently the only way to prevent hepatitis D caused by the HDV virus is to get vaccinated against hepatitis D caused by the HBV virus.
In addition, you can refer to some measures to reduce the risk of HDV infection:
Immunize young children or groups of adults who are at high risk of HDV infection (drug users and sharing needles). Practice safe sex, use condoms at all times with your partner. Should be careful with tattoos and piercings, should only choose trusted shops, require staff to clean and sterilize tools before use. Hepatitis D is an infection caused by a virus that leads to inflammation of the liver. Currently, most adults who are infected with hepatitis D will be able to make a full recovery with medication prescribed by their doctor, even if their symptoms or signs are severe. Therefore, if you notice that your body has signs and symptoms as we have listed, go to reputable medical facilities to conduct an examination, find out the cause and be diagnosed and treated promptly. time.