Table of ContentsView AllTable of ContentsTypesHepatitis D SymptomsCausesDiagnosisTreatmentPreventionRecommended Lifestyle Changes
Table of ContentsView All
View All
Table of Contents
Types
Hepatitis D Symptoms
Causes
Diagnosis
Treatment
Prevention
Recommended Lifestyle Changes
Hepatitis Dis a type ofviral hepatitisthat affects around 48 million people worldwide.It is less common than other types of hepatitis that you might be more familiar with.
Hepatitis D is thought to be uncommon in the United States.It is mostly seen in developing nations where hepatitis B is widespread.
Even though it is uncommon, HDV is considered to be the most severe form of viral hepatitis and comes with a high risk of complications, includingcirrhosis,liver failure, andliver cancer.
Hepatitis D is associated with the rapid progression of liver disease in chronically infected people and has a mortality rate of around 20%—higher than any other form of viral hepatitis.
As with otherforms of viral hepatitis, hepatitis D can cause an acute (short-term) infection that often resolves on its own without any problems. However, in some people, the infection can persist and become chronic (long term), causing progressive injury to the liver.
How and when you get hepatitis D can make a big difference in the course of the infection. There are two different ways that a person can get the virus.
The differences might not sound extreme, but a superinfection is considered to be a far more serious condition. Around 80% of superinfected people will go on to develop a chronic infection compared to only 5% of coinfected individuals.
HDV superinfection is also associated with the rapid progression of liver disease. In those who are chronically infected, between 70% and 80% will develop cirrhosis and liver failure within five to 10 years, while 15% will experience the same within one to two years.This is double the rate seen in people chronically infected with HBV on its own.
Which Types of Hepatitis Have Higher Complications?
Genotypes
Acute Stage
As with other forms of viral hepatitis, the majority of people infected with HDV will experience no obvious signs and symptoms during the acute phase.
If theimmune systemis able to clear the infection, people may not even know that they’ve been infected.
If symptoms do develop, they are difficult to tell apart from those of other forms of viral hepatitis. The most common symptoms are:
Acute symptoms tend to resolve within two to four weeks, although it may take longer for jaundice to fully disappear.
In rare cases, an acute HDV infection can lead to fulminant hepatitis, a potentially life-threatening condition that causes liver tissue death (necrosis) andacute liver failure.
Symptoms of this complication include jaundice, vomiting, abdominal swelling, confusion, tremors, and a fruity breath smell.
Fulminant hepatitis involves extreme liver function failure. It occurs in less than 1% of all acute HBV infections. When HDV is involved, the risk can jump to as much as twentyfold.
Symptoms and Complications of Acute Viral Hepatitis
Chronic Stage
Chronic hepatitis D occurs when the immune system is unable to clear the virus. Once the acute symptoms have resolved, the infection can remain “silent” for years and even decades, causing progressive injury to the liver even if a person is not aware of it.
The first signs of chronic hepatitis are often associated with the onset ofcirrhosis, a condition in which the buildup of scar tissues impairs the function of the liver.
The symptoms are progressive and may include:
Cirrhosis is said to be “compensated” when the liver is damaged but still relatively functional. When it is “decompensated,” the liver is no longer functional.
With hepatitis D, the risk of decompensated cirrhosis and liver failure is greater than with any other form of viral hepatitis—especially in people with HDV superinfection.
In addition to cirrhosis, people with chronic hepatitis D are also at a two-fold greater risk of developingliver cancerthan people with HBV alone.
What Are the Warning Signs of Liver Cancer?
The hepatitis D virus, also known as the delta virus, is unique in that it cannot replicate on its own.It is considered a “satellite virus” because it needs HBV to complete its life cycle and make copies of itself.
In most cases, HDV is the dominant virus in the infection. As it suppresses HBV to low levels, it utilizes HBV’s surface proteins to assemble new copies of itself. Any liver damage that occurs, therefore, is the result of hepatitis D rather than hepatitis B.
Hepatitis D ismainly spreadthrough blood exposure. Shared needles and syringes are among the most common causes.
In developing nations where HDV isendemic, unsterile medical devices, contaminated blood or clotting factor, and shared personal care items (like barbershop razors) are also sources of infection.
Sexual transmission of HDV is uncommon but can occur. HDV transmission from pregnant person to child during childbirth, while possible, is thought to be rare.
Hepatitis D is not spread through contaminated food or water, shared utensils, breastfeeding, kissing, coughing, or sneezing.
HDV is most common in East Africa, central and northern regions of Asia, the Amazon Basin, the Middle East, and certain areas of the Pacific.
How Different Types of Viral Hepatitis Are Transmitted
Arguably the biggest challenge in diagnosing hepatitis D is recognizing the signs of infection. Because hepatitis D is uncommon in the United States, it can sometimes be overlooked in a patient—particularly in cases of HBV/HDV coinfection.
While there can be many causes for the rebound ofhepatitis symptoms, certain clues suggest that HDV is involved (such as travel to an endemic region or injection drug use).
HDV Screening RecommendationsThe American Association for the Study of Liver Disease (AASLD) recommends HDV screening for anyone with hepatitis B who is at highrisk for hepatitis D, including injecting drug users, people withHIV,men who have sex with men, and people arriving from countries where HDV is endemic.
HDV Screening Recommendations
The American Association for the Study of Liver Disease (AASLD) recommends HDV screening for anyone with hepatitis B who is at highrisk for hepatitis D, including injecting drug users, people withHIV,men who have sex with men, and people arriving from countries where HDV is endemic.
If HDV is suspected, it can be diagnosed using a series of simple blood tests.
Total Antibody Test
Based on which antibodies are elevated, the test can not only confirm that an infection is present but also establish the pattern of infection. The IgM/IgG pattern can help determine if the infection is acute or chronic, or if a coinfection or superinfection is involved.
PCR Qualitative Tests
Tests known as PCR qualitative tests are typically performed if a total antibody test is positive. Rather than looking at the “footprint” of the infection (that is, antibodies), this test looks at the virus itself using a technology calledpolymerase chain reaction (PCR)that detects viral RNA.
The PCR test can both confirm the diagnosis and indicate if the infection is active. Factors like this can help direct the appropriate course of treatment.
Other Tests and Procedures
Once hepatitis D is diagnosed, other tests are performed on a routine basis to monitor the disease’s progression and a person’s response to treatment.
Given the availability of noninvasive tests, aliver biopsyis less commonly used for disease staging. However, if the diagnosis is unclear or if a co-occurring condition such asmetabolic dysfunction-associated steatotic liver disease(MASLD, formerly known as NAFLD) oralcohol-associated liver disease (AALD)is involved, it might be used.
Unlike hepatitis B, there are no treatments available specifically for hepatitis D.
People with chronic hepatitis B should see a specialist experienced in managing such infections and take medications to help suppress replication and work toward remission of liver disease.
Antiviral drugs that are commonly used to treat HBV, like Viread (tenofovir) and Baraclude (entecavir), generally have little effect on HDV. However, they might be used on an experimental basis in combination therapies.
Pegylated Interferon-Alpha
Pegylated interferon-alpha (IFN-a), a drug used for the treatment of hepatitis B andhepatitis Csince the early 2000s, is typically used as the first-line (initial) treatment of hepatitis D.
Studies have shown that pegylated IFN-a helps one in four people with chronic HDV achieve a sustained undetectable viral load within six months. However, the viral load will typically rebound once the treatment is stopped.
Pegylated IFN-a is also known to cause significant toxicity with ongoing use.Common side effects include:
The long-term use of pegylated IFN-a can also increase the risk of diabetes, thyroid disease, kidney dysfunction, seizures, and certain autoimmune diseases.
Other Treatments
A few experimental drugs have shown promise in the treatment of HDV. Among some of the leading candidates are:
Liver Transplant
The only viable treatment for people with decompensated cirrhosis is aliver transplant.
A 2019 study published inTransplant Proceedingsfound that only 14% of people who underwent a liver transplant for HDV experienced recurrence.
Do I Qualify for a Liver Transplant?
The best way to prevent hepatitis D is to prevent hepatitis B. By getting vaccinated with one of three approvedhepatitis B vaccines—Engerix-B, Recombivax HB, or Heplisav B—you can prevent HDV from causing harm if you do get infected.
Although HDV can enter cells on its own, it cannot replicate without HBV. Without the means to rapidly grow, HDV cannot cause disease.
Preventing Hepatitis B in Adults with Heplisav-B
A Word From Verywell
It can be distressing to learn that you have hepatitis D. Coming to terms with the diagnosis may take time, but with education and support, you can learn how you manage your condition and protect your liver from avoidable harm.
Being under the care of a qualifiedgastroenterologistorhepatologistis key to maintaining your health. By seeing your doctor regularly and monitoring the status of your liver, your doctor can act quickly if complications arise and even detect problems before they occur.
If current treatments do not work for you, you may wish to learn about developing research and exploreclinical trials. As scientists learn more about hepatitis D, the hope is that a breakthrough like the one seen with hepatitis C—a disease considered incurable just 20 years ago—could be on the horizon.
Do I Need a Hepatologist or Gastroenterologist?
26 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Miao Z, Zhang S, Ou X, et al.Estimating the global prevalence, disease progression, and clinical outcome of hepatitis delta virus infection.J Infect Dis.2020;221(10):1677-87. doi:10.1093/infdis/jiz633Mentha N, Clément S, Negro F, et al.A review on hepatitis D: from virology to new therapies.J Adv Res.2019;17:3-15. doi:10.1016/j.jare.2019.03.009Centers for Disease Control and Prevention.Hepatitis D questions and answers for health professionals.Negro F.Hepatitis D virus coinfection and superinfection.Cold Spring Harbor Perspect Med. 2014;4(11):a021550-a021550. doi:10.1101/cshperspect.a021550Bhat M, Ghali P, Deschenes M, Wong P.Prevention and management of chronic hepatitis B.Int J Prev Med. 2014;5(Suppl 3):S200-7.Niro GA, Smedile A, Andriulli A, et al.The predominance of hepatitis delta virus genotype I among chronically infected Italian patients.Hepatology. 1997;25(3):728-734. doi:10.1002/hep.510250339Manka P, Verheyen J, Gerken G, et al.Liver failure due to acute viral hepatitis(A-E).Visc Med. 2016;32(2):80-5. doi:10.1159/000444915National Institute of Diabetes and Digestive and Kidney Diseases.Chronic hepatitis.Abeywickrama-Samarakoon N, Cortay JC, Dény P.The hepatitis D satellite virus of hepatitis B virus: half-opening a new era to control viral infection?.Curr Opin Infect Dis.2016;29(6):645-53. doi:10.1097/QCO.0000000000000321National Organization for Rare Disorders.Hepatitis D.Terrault NA, Lok ASF, McMahon BJ, et al.Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance.Hepatology. 2018;67(4):1560-99. doi:10.1002/hep.29800Mederacke I, Bremer B, Heidrich B, et al.Establishment of a novel quantitative hepatitis D virus (HDV) RNA assay using the Cobas TaqMan platform to study HDV RNA kinetics.J Clin Microbiol. 2010;48(6):2022-2029. doi:10.1128/JCM.00084-10Centers for Disease Control and Prevention.Sexually Transmitted Infections Treatment Guidelines, 2021.Alavian S-M, Tabatabaei SV, Behnava B, Rizzetto M.Standard and pegylated interferon therapy of HDV infection: a systematic review and meta-analysis.J Res Med Sci.2012;17(10):967-74.Sleijfer S, Bannink M, Van Gool AR, et al.Side effects of interferon-alpha therapy.Pharm World Sci. 2005;27(6):423-431. doi:10.1007/s11096-005-1319-7Kang C, Syed YY.Bulevirtide: first approval.Drugs. 2020;80(15):1601-5. doi:10.1007/s40265-020-01400-1Dhillon S.Lonafarnib: first approval.Drugs.2021;81(2):283-9. doi:10.1007/s40265-020-01464-zSerin A, Tokat Y.Recurrence of hepatitis D virus in liver transplant recipients with hepatitis B and D virus-related chronic liver disease.Transplant Proc. 2019;51(7):2457-60. doi:10.1016/j.transproceed.2019.01.163Schille S, Harris A, Link-Gelles R, et al.Recommendations of the Advisory Committee on Immunization Practices for use of a hepatitis B vaccine with a novel adjuvant.MMWR Morb Mortal Wkly Rep. 2018;67(15):455-8. doi:10.15585/mmwr.mm6715a5Dolganiuc A.Alcohol and viral hepatitis: role of lipid rafts.Alcohol Res. 2015;37(2):299-309.Wang Y, Chuang Y, Wu C, et al.Smoking and hepatitis B virus–related hepatocellular carcinoma risk: the mediating roles of viral load and alanine aminotransferase.Hepatology. 2019;69(4):1412-25. doi:10.1002/hep.30339Chang Y, Liu Q-Y, Zhang Q, et al.Role of nutritional status and nutritional support in outcome of hepatitis B virus-associated acute-on-chronic liver failure.WJG.2020;26(29):4288-301. doi:10.3748/wjg.v26.i29.4288Nazir S, Brown K, Shin AK, et al.Vibrio vulnificus infection and liver cirrhosis: a potentially lethal combination.Case Rep. 2016;2016:bcr2016214772. doi:10.1136/bcr-2016-214772Guan Y-S, He Q.Plants consumption and liver health.Evid Based Compl Alt Med.2015;2015:1-10. doi:10.1155/2015/824185Francis P, Navarro VJ.Drug induced hepatotoxicity. In:StatPearls [Internet].Centers for Disease Control and Prevention.Hepatitis A questions and answers for health professionals.
26 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Miao Z, Zhang S, Ou X, et al.Estimating the global prevalence, disease progression, and clinical outcome of hepatitis delta virus infection.J Infect Dis.2020;221(10):1677-87. doi:10.1093/infdis/jiz633Mentha N, Clément S, Negro F, et al.A review on hepatitis D: from virology to new therapies.J Adv Res.2019;17:3-15. doi:10.1016/j.jare.2019.03.009Centers for Disease Control and Prevention.Hepatitis D questions and answers for health professionals.Negro F.Hepatitis D virus coinfection and superinfection.Cold Spring Harbor Perspect Med. 2014;4(11):a021550-a021550. doi:10.1101/cshperspect.a021550Bhat M, Ghali P, Deschenes M, Wong P.Prevention and management of chronic hepatitis B.Int J Prev Med. 2014;5(Suppl 3):S200-7.Niro GA, Smedile A, Andriulli A, et al.The predominance of hepatitis delta virus genotype I among chronically infected Italian patients.Hepatology. 1997;25(3):728-734. doi:10.1002/hep.510250339Manka P, Verheyen J, Gerken G, et al.Liver failure due to acute viral hepatitis(A-E).Visc Med. 2016;32(2):80-5. doi:10.1159/000444915National Institute of Diabetes and Digestive and Kidney Diseases.Chronic hepatitis.Abeywickrama-Samarakoon N, Cortay JC, Dény P.The hepatitis D satellite virus of hepatitis B virus: half-opening a new era to control viral infection?.Curr Opin Infect Dis.2016;29(6):645-53. doi:10.1097/QCO.0000000000000321National Organization for Rare Disorders.Hepatitis D.Terrault NA, Lok ASF, McMahon BJ, et al.Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance.Hepatology. 2018;67(4):1560-99. doi:10.1002/hep.29800Mederacke I, Bremer B, Heidrich B, et al.Establishment of a novel quantitative hepatitis D virus (HDV) RNA assay using the Cobas TaqMan platform to study HDV RNA kinetics.J Clin Microbiol. 2010;48(6):2022-2029. doi:10.1128/JCM.00084-10Centers for Disease Control and Prevention.Sexually Transmitted Infections Treatment Guidelines, 2021.Alavian S-M, Tabatabaei SV, Behnava B, Rizzetto M.Standard and pegylated interferon therapy of HDV infection: a systematic review and meta-analysis.J Res Med Sci.2012;17(10):967-74.Sleijfer S, Bannink M, Van Gool AR, et al.Side effects of interferon-alpha therapy.Pharm World Sci. 2005;27(6):423-431. doi:10.1007/s11096-005-1319-7Kang C, Syed YY.Bulevirtide: first approval.Drugs. 2020;80(15):1601-5. doi:10.1007/s40265-020-01400-1Dhillon S.Lonafarnib: first approval.Drugs.2021;81(2):283-9. doi:10.1007/s40265-020-01464-zSerin A, Tokat Y.Recurrence of hepatitis D virus in liver transplant recipients with hepatitis B and D virus-related chronic liver disease.Transplant Proc. 2019;51(7):2457-60. doi:10.1016/j.transproceed.2019.01.163Schille S, Harris A, Link-Gelles R, et al.Recommendations of the Advisory Committee on Immunization Practices for use of a hepatitis B vaccine with a novel adjuvant.MMWR Morb Mortal Wkly Rep. 2018;67(15):455-8. doi:10.15585/mmwr.mm6715a5Dolganiuc A.Alcohol and viral hepatitis: role of lipid rafts.Alcohol Res. 2015;37(2):299-309.Wang Y, Chuang Y, Wu C, et al.Smoking and hepatitis B virus–related hepatocellular carcinoma risk: the mediating roles of viral load and alanine aminotransferase.Hepatology. 2019;69(4):1412-25. doi:10.1002/hep.30339Chang Y, Liu Q-Y, Zhang Q, et al.Role of nutritional status and nutritional support in outcome of hepatitis B virus-associated acute-on-chronic liver failure.WJG.2020;26(29):4288-301. doi:10.3748/wjg.v26.i29.4288Nazir S, Brown K, Shin AK, et al.Vibrio vulnificus infection and liver cirrhosis: a potentially lethal combination.Case Rep. 2016;2016:bcr2016214772. doi:10.1136/bcr-2016-214772Guan Y-S, He Q.Plants consumption and liver health.Evid Based Compl Alt Med.2015;2015:1-10. doi:10.1155/2015/824185Francis P, Navarro VJ.Drug induced hepatotoxicity. In:StatPearls [Internet].Centers for Disease Control and Prevention.Hepatitis A questions and answers for health professionals.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Miao Z, Zhang S, Ou X, et al.Estimating the global prevalence, disease progression, and clinical outcome of hepatitis delta virus infection.J Infect Dis.2020;221(10):1677-87. doi:10.1093/infdis/jiz633Mentha N, Clément S, Negro F, et al.A review on hepatitis D: from virology to new therapies.J Adv Res.2019;17:3-15. doi:10.1016/j.jare.2019.03.009Centers for Disease Control and Prevention.Hepatitis D questions and answers for health professionals.Negro F.Hepatitis D virus coinfection and superinfection.Cold Spring Harbor Perspect Med. 2014;4(11):a021550-a021550. doi:10.1101/cshperspect.a021550Bhat M, Ghali P, Deschenes M, Wong P.Prevention and management of chronic hepatitis B.Int J Prev Med. 2014;5(Suppl 3):S200-7.Niro GA, Smedile A, Andriulli A, et al.The predominance of hepatitis delta virus genotype I among chronically infected Italian patients.Hepatology. 1997;25(3):728-734. doi:10.1002/hep.510250339Manka P, Verheyen J, Gerken G, et al.Liver failure due to acute viral hepatitis(A-E).Visc Med. 2016;32(2):80-5. doi:10.1159/000444915National Institute of Diabetes and Digestive and Kidney Diseases.Chronic hepatitis.Abeywickrama-Samarakoon N, Cortay JC, Dény P.The hepatitis D satellite virus of hepatitis B virus: half-opening a new era to control viral infection?.Curr Opin Infect Dis.2016;29(6):645-53. doi:10.1097/QCO.0000000000000321National Organization for Rare Disorders.Hepatitis D.Terrault NA, Lok ASF, McMahon BJ, et al.Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance.Hepatology. 2018;67(4):1560-99. doi:10.1002/hep.29800Mederacke I, Bremer B, Heidrich B, et al.Establishment of a novel quantitative hepatitis D virus (HDV) RNA assay using the Cobas TaqMan platform to study HDV RNA kinetics.J Clin Microbiol. 2010;48(6):2022-2029. doi:10.1128/JCM.00084-10Centers for Disease Control and Prevention.Sexually Transmitted Infections Treatment Guidelines, 2021.Alavian S-M, Tabatabaei SV, Behnava B, Rizzetto M.Standard and pegylated interferon therapy of HDV infection: a systematic review and meta-analysis.J Res Med Sci.2012;17(10):967-74.Sleijfer S, Bannink M, Van Gool AR, et al.Side effects of interferon-alpha therapy.Pharm World Sci. 2005;27(6):423-431. doi:10.1007/s11096-005-1319-7Kang C, Syed YY.Bulevirtide: first approval.Drugs. 2020;80(15):1601-5. doi:10.1007/s40265-020-01400-1Dhillon S.Lonafarnib: first approval.Drugs.2021;81(2):283-9. doi:10.1007/s40265-020-01464-zSerin A, Tokat Y.Recurrence of hepatitis D virus in liver transplant recipients with hepatitis B and D virus-related chronic liver disease.Transplant Proc. 2019;51(7):2457-60. doi:10.1016/j.transproceed.2019.01.163Schille S, Harris A, Link-Gelles R, et al.Recommendations of the Advisory Committee on Immunization Practices for use of a hepatitis B vaccine with a novel adjuvant.MMWR Morb Mortal Wkly Rep. 2018;67(15):455-8. doi:10.15585/mmwr.mm6715a5Dolganiuc A.Alcohol and viral hepatitis: role of lipid rafts.Alcohol Res. 2015;37(2):299-309.Wang Y, Chuang Y, Wu C, et al.Smoking and hepatitis B virus–related hepatocellular carcinoma risk: the mediating roles of viral load and alanine aminotransferase.Hepatology. 2019;69(4):1412-25. doi:10.1002/hep.30339Chang Y, Liu Q-Y, Zhang Q, et al.Role of nutritional status and nutritional support in outcome of hepatitis B virus-associated acute-on-chronic liver failure.WJG.2020;26(29):4288-301. doi:10.3748/wjg.v26.i29.4288Nazir S, Brown K, Shin AK, et al.Vibrio vulnificus infection and liver cirrhosis: a potentially lethal combination.Case Rep. 2016;2016:bcr2016214772. doi:10.1136/bcr-2016-214772Guan Y-S, He Q.Plants consumption and liver health.Evid Based Compl Alt Med.2015;2015:1-10. doi:10.1155/2015/824185Francis P, Navarro VJ.Drug induced hepatotoxicity. In:StatPearls [Internet].Centers for Disease Control and Prevention.Hepatitis A questions and answers for health professionals.
Miao Z, Zhang S, Ou X, et al.Estimating the global prevalence, disease progression, and clinical outcome of hepatitis delta virus infection.J Infect Dis.2020;221(10):1677-87. doi:10.1093/infdis/jiz633
Mentha N, Clément S, Negro F, et al.A review on hepatitis D: from virology to new therapies.J Adv Res.2019;17:3-15. doi:10.1016/j.jare.2019.03.009
Centers for Disease Control and Prevention.Hepatitis D questions and answers for health professionals.
Negro F.Hepatitis D virus coinfection and superinfection.Cold Spring Harbor Perspect Med. 2014;4(11):a021550-a021550. doi:10.1101/cshperspect.a021550
Bhat M, Ghali P, Deschenes M, Wong P.Prevention and management of chronic hepatitis B.Int J Prev Med. 2014;5(Suppl 3):S200-7.
Niro GA, Smedile A, Andriulli A, et al.The predominance of hepatitis delta virus genotype I among chronically infected Italian patients.Hepatology. 1997;25(3):728-734. doi:10.1002/hep.510250339
Manka P, Verheyen J, Gerken G, et al.Liver failure due to acute viral hepatitis(A-E).Visc Med. 2016;32(2):80-5. doi:10.1159/000444915
National Institute of Diabetes and Digestive and Kidney Diseases.Chronic hepatitis.
Abeywickrama-Samarakoon N, Cortay JC, Dény P.The hepatitis D satellite virus of hepatitis B virus: half-opening a new era to control viral infection?.Curr Opin Infect Dis.2016;29(6):645-53. doi:10.1097/QCO.0000000000000321
National Organization for Rare Disorders.Hepatitis D.
Terrault NA, Lok ASF, McMahon BJ, et al.Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance.Hepatology. 2018;67(4):1560-99. doi:10.1002/hep.29800
Mederacke I, Bremer B, Heidrich B, et al.Establishment of a novel quantitative hepatitis D virus (HDV) RNA assay using the Cobas TaqMan platform to study HDV RNA kinetics.J Clin Microbiol. 2010;48(6):2022-2029. doi:10.1128/JCM.00084-10
Centers for Disease Control and Prevention.Sexually Transmitted Infections Treatment Guidelines, 2021.
Alavian S-M, Tabatabaei SV, Behnava B, Rizzetto M.Standard and pegylated interferon therapy of HDV infection: a systematic review and meta-analysis.J Res Med Sci.2012;17(10):967-74.
Sleijfer S, Bannink M, Van Gool AR, et al.Side effects of interferon-alpha therapy.Pharm World Sci. 2005;27(6):423-431. doi:10.1007/s11096-005-1319-7
Kang C, Syed YY.Bulevirtide: first approval.Drugs. 2020;80(15):1601-5. doi:10.1007/s40265-020-01400-1
Dhillon S.Lonafarnib: first approval.Drugs.2021;81(2):283-9. doi:10.1007/s40265-020-01464-z
Serin A, Tokat Y.Recurrence of hepatitis D virus in liver transplant recipients with hepatitis B and D virus-related chronic liver disease.Transplant Proc. 2019;51(7):2457-60. doi:10.1016/j.transproceed.2019.01.163
Schille S, Harris A, Link-Gelles R, et al.Recommendations of the Advisory Committee on Immunization Practices for use of a hepatitis B vaccine with a novel adjuvant.MMWR Morb Mortal Wkly Rep. 2018;67(15):455-8. doi:10.15585/mmwr.mm6715a5
Dolganiuc A.Alcohol and viral hepatitis: role of lipid rafts.Alcohol Res. 2015;37(2):299-309.
Wang Y, Chuang Y, Wu C, et al.Smoking and hepatitis B virus–related hepatocellular carcinoma risk: the mediating roles of viral load and alanine aminotransferase.Hepatology. 2019;69(4):1412-25. doi:10.1002/hep.30339
Chang Y, Liu Q-Y, Zhang Q, et al.Role of nutritional status and nutritional support in outcome of hepatitis B virus-associated acute-on-chronic liver failure.WJG.2020;26(29):4288-301. doi:10.3748/wjg.v26.i29.4288
Nazir S, Brown K, Shin AK, et al.Vibrio vulnificus infection and liver cirrhosis: a potentially lethal combination.Case Rep. 2016;2016:bcr2016214772. doi:10.1136/bcr-2016-214772
Guan Y-S, He Q.Plants consumption and liver health.Evid Based Compl Alt Med.2015;2015:1-10. doi:10.1155/2015/824185
Francis P, Navarro VJ.Drug induced hepatotoxicity. In:StatPearls [Internet].
Centers for Disease Control and Prevention.Hepatitis A questions and answers for health professionals.
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