Introduction:
The presence of the hepatitis B virus (HBV) is necessary for the development and replication of the hepatitis D or delta virus (HDV), a defective single-stranded RNA virus. The lipoprotein coat of HDV, a 35–37 nm spherical particle, was produced from HBsAg. The 1680 nucleotides that makeup HDV-RNA are only replicated in hepatocytes. In terms of RNA genome size, it is thought to be the smallest animal virus.
.png "What is Hepatitis D?") |
| What is Hepatitis D? |
PREVALENCE
HDV is available everywhere. It is widespread in the developing world, with South America having the highest prevalence. Like hepatitis B, HDV infection is only present in people with HBV infection and is acquired. Around 5% of HBV carriers worldwide have anti-HDV positivity. One persistent issue among those who use intravenous drugs is delta hepatitis.
PATHOPHYSIOLOGY
Patients may get HDV with hepatitis B infection (acute coinfection) or after contracting the virus from hepatitis B infection (superinfection). It is still unclear whether the virus is cytotoxic or whether the disease is caused by an immune-mediated response. In chronic disease, an immunological response may be the main mediator, whereas, in an acute infection, direct viral cytotoxicity may be the main mediator.
Although the histologic characteristics are non-specific for persistent HDV infection, the necroinflammatory activity is considerable.
SIGNS AND SYMPTOMS
The majority of patients with HDV infection have subclinical sickness, and the symptoms are non-specific.
While most individuals who contract HDV and HBV simultaneously can remove the delta virus, 70–90% of those who are superinfected go on to develop persistent delta infection.
Superinfection causes acute illnesses that are more severe than those caused by HBV alone and increases the chance of fulminant hepatic failure, which happens in 5% to 20% of cases.
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| Symptoms of Hep D |
DIAGNOSIS
Only in cases of confirmed HBV infection should delta hepatitis be diagnosed. Finding positive serum HBsAg, HBV DNA, or both indicates this. The diagnosis can be made by utilizing ELISA to measure antibodies to delta antigens. After viral clearance, though, it could still be positive, especially if HBV and HDV are co-infected. IgM antibodies are not elevated during the acute disease but also when there is liver damage; they appear to subside when hepatitis clears up.
The presence of HDV antigen in the serum and HDV RNA, which is only accessible in a laboratory setting, both serve to confirm the diagnosis. In persistent HDV infection, anti-HDV antibody (IgG) can show up in high titers; yet, after viral clearance, lesser titers may be found.
TREATMENT
The Hepatitis B vaccine helps protect against developing delta hepatitis. There is currently no effective vaccine to protect chronic hepatitis B carriers against delta hepatitis. High-dose interferon up to 9 million U three times per week for a year can be used to treat delta hepatitis. Even while up to 70% of patients eradicate the virus and achieve normal liver enzyme levels, almost all patients experience relapses at some point after treatment. Decompensated patients may be candidates for orthotopic liver transplantation. It's interesting to note that people who have HDV and have a liver transplant have a better prognosis for the graft than those who only need a transplant for hepatitis B.
This phenomenon might be brought on by HDV's inhibition of HBV replication. These people receive hepatitis B immunoglobulin treatment.
OUTCOMES
Cirrhosis or hepatocellular cancer can develop as a result of chronic HDV and HBV infection, which can also cause severe fulminant hepatitis and liver failure.
Inactive phases of chronic infections can last for a long time, and some patients experience full remission.
Patients with delta hepatitis are more likely to develop cirrhosis than those who are only infected with hepatitis B.
They are also more likely to develop hepatocellular carcinoma. Patients who have hepatitis C and the human immunodeficiency virus suffer worse outcomes.
SUMMARY
- The presence of the hepatitis B virus (HBV) is necessary for the development and replication of the hepatitis D or delta virus (HDV), a defective single-stranded RNA virus. HDV is available everywhere. It is widespread in poorer nations.
- Like hepatitis B, HDV infection is only present in people with HBV infection and is acquired.
- With HDV infection, acute sickness is more severe than with HBV alone,
- and there is a greater chance of developing fulminant hepatic failure, which happens in 5% to 20% of patients.
- Patients with delta hepatitis have a larger likelihood of developing cirrhosis than those who only have hepatitis B,
- and they also have a higher chance of developing hepatocellular cancer.
- The Hepatitis B vaccine helps protect against developing delta hepatitis.
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