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                    Liver Disease
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                    Hepatitis D

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        Hepatitis (Viral)
        What Is Viral Hepatitis?
                Hepatitis A
                Hepatitis B
                Hepatitis C
                Hepatitis D
                Hepatitis EHepatitis D
**In this section:**
What is hepatitis D?
    How do hepatitis D and hepatitis B infections occur together?
    How common is hepatitis D?
    Who is more likely to have hepatitis D?
    What are the complications of acute hepatitis D?
    What are the complications of chronic hepatitis D?
    What are the symptoms of hepatitis D?
    What causes hepatitis D?
    How do doctors diagnose hepatitis D?
    What tests do doctors use to diagnose hepatitis D?
    How do doctors treat hepatitis D?
    How do doctors treat the complications of hepatitis D?
    How can I protect myself from hepatitis D infection?
    How can I prevent spreading hepatitis D to others?
    Is a hepatitis D vaccine available?
    Eating, diet, and nutrition for hepatitis DWhat is hepatitis D?
Hepatitis D is a viral  infection that causes liver inflammation and damage. Inflammation is swelling  that occurs when tissues of the body become injured or infected. Inflammation  can damage organs.
Viruses invade normal cells in your body. Many viruses cause  infections that can spread from person to person.
The hepatitis D virus is  unusual because it can only infect you when you also have a hepatitis  B virus infection. In this way, hepatitis D is a double  infection. You can protect  yourself from hepatitis D by protecting yourself from hepatitis B by getting the hepatitis B  vaccine.
Hepatitis D spreads the same  way that hepatitis B spreads, through contact with an infected person’s blood  or other body fluids.
The hepatitis D virus can cause an acute or chronic infection, or both.
Acute hepatitis D
Acute hepatitis D is a  short-term infection. The symptoms of  acute hepatitis D are the same as the symptoms of any type of hepatitis and are  often more severe.19 Sometimes your body is able to fight off the  infection and the virus goes away.
Chronic hepatitis D
Chronic hepatitis D is a long-lasting infection. Chronic hepatitis D occurs when your body is not able to fight off the virus and the virus does not go away. People who have chronic hepatitis B and D develop complications more often and more quickly than people who have chronic hepatitis B alone.20
How do hepatitis D and hepatitis B infections occur together?
Hepatitis D and hepatitis B infections may occur together as a coinfection or a superinfection. People can only become infected with hepatitis D when they also have hepatitis B.
Coinfection
A coinfection occurs when you get both hepatitis D and hepatitis B infections at the same time. Coinfections usually cause acute, or short-term, hepatitis D and B infections. Coinfections may cause severe acute hepatitis.
In most cases, people are able to recover from and fight off the acute hepatitis D and B infections and the viruses go away. However, in less than 5 percent of people with a coinfection, both infections become chronic and do not go away.21
Superinfection
A superinfection occurs if you already have chronic hepatitis B and then become infected with hepatitis D. When you get a superinfection, you may have severe acute hepatitis symptoms.19
Up to 90 percent of people with a superinfection are not able to fight off the hepatitis D virus, and develop chronic hepatitis D.20 As a result, these people will have both chronic hepatitis D and chronic hepatitis B.
How common is hepatitis D?
Hepatitis D is not common in the United States.  Hepatitis D is more common in other parts of the world, including Eastern and Southern Europe; the Mediterranean region and Middle East; parts of Asia, including Mongolia; Central Africa; and the Amazon River basin in South America.22,23
Who is more likely to have hepatitis D?
Hepatitis D infection occurs only in people who have  hepatitis B. People are more likely to have hepatitis D in addition to  hepatitis B if they
are injection-drug users
    have lived with or had sex with someone who has hepatitis D
    are from an area of the world where hepatitis D is more commonWhat are the complications of acute hepatitis D?
In rare cases, acute hepatitis D can lead to acute liver failure, a condition in which the liver fails suddenly. Although acute liver failure is uncommon, hepatitis D and B infections are more likely to lead to acute liver failure than hepatitis B infection alone.24
What are the complications of chronic hepatitis D?
Chronic hepatitis D may lead to cirrhosis, liver failure, and liver cancer. People who have chronic hepatitis B and D are more likely to develop these complications than people who have chronic hepatitis B alone.20 Early diagnosis and treatment of chronic hepatitis B and D can lower your chances of developing serious health problems.
Cirrhosis
Cirrhosis is a condition in which the liver slowly breaks down and is unable to work normally. Scar tissue replaces healthy liver tissue, partly blocking the flow of blood through the liver. In the early stages of cirrhosis, the liver continues to work. As cirrhosis gets worse, the liver begins to fail.
Liver failure
Also called end-stage liver disease, liver failure progresses over months or years. With end-stage liver disease, the liver can no longer perform important functions or replace damaged cells.
Liver cancer
Having  chronic hepatitis B and chronic hepatitis D increases your chance of developing liver cancer. Your doctor may suggest blood tests and an ultrasound or other type of imaging test to check for liver  cancer. Finding cancer at an early stage improves the chance of  curing the cancer.
What are the symptoms of hepatitis D?
Most people with acute hepatitis D have symptoms, which may  include
feeling tired
    nausea and vomiting
    poor appetite
    pain over the liver, in the upper part of the abdomen
    darkening of the color of urine
    lightening of the color of stool
    yellowish tint to the whites of the eyes and skin, called jaundiceIn contrast, most people with chronic hepatitis D have few  symptoms until complications develop, which could be several years after they  were infected. Some symptoms of cirrhosis include
weakness and feeling tired
    weight loss
    swelling of the abdomen
    swelling of the ankles, called edema
    itching skin
    jaundiceWhat causes hepatitis D?
The hepatitis D virus causes  hepatitis D. The hepatitis D virus spreads through contact with an infected  person’s blood or other body fluids. Contact can occur by
sharing  drug needles or other drug materials with an infected person
    having  unprotected sex with an infected person
    getting  an accidental stick with a needle that was used on an infected personThe hepatitis D virus rarely spreads from mother to child during birth.
You can’t get hepatitis D from
being  coughed on or sneezed on by an infected person
    drinking  water or eating food
    hugging  an infected person
    shaking  hands or holding hands with an infected person
    sharing  spoons, forks, and other eating utensils
    sitting  next to an infected personHow do doctors diagnose hepatitis D?
Doctors diagnose hepatitis D based on your medical history, a physical exam, and blood tests. If you have hepatitis D, your doctor may perform tests to check your liver.
Medical history
Your doctor will ask about your symptoms and about factors that may make you more likely to get hepatitis D.
Physical exam
During a physical exam, your doctor will  check for signs of liver damage such as
changes in  skin color
    swelling in  your lower legs, feet, or ankles
    tenderness or  swelling in your abdomenWhat tests do doctors use to diagnose hepatitis D?
Doctors use blood tests to diagnose hepatitis D. Your doctor may order tests to check for liver damage, find out how much liver damage you have, or rule out other causes of liver disease.
Blood test
Your doctor may order one or more blood tests to diagnose hepatitis D. A health care professional will take a blood sample from you and send the sample to a lab.

A health care professional collecting blood from a patient.Your doctor may order one or more blood tests to diagnose hepatitis D.Additional tests
If you have chronic hepatitis D and hepatitis B, you could have liver  damage. Your doctor may recommend tests to find out whether you have liver  damage or how much liver damage you have—or to rule out other causes of liver  disease. These tests may include
blood tests.
    elastography, a special ultrasound that measures the stiffness of your liver.
    a liver biopsy, in which a doctor uses a needle to take a small piece of tissue from your  liver. A pathologist will examine the tissue under a microscope to  look for signs of damage or disease.Doctors typically use liver biopsy only if other tests don’t provide enough information about the liver damage or disease. Talk with your doctor about which tests are best for you.
How do doctors treat hepatitis D?
Doctors may treat chronic hepatitis D with medicines called  interferons, such as peginterferon alfa-2a (Pegasys). Researchers are studying new treatments for hepatitis D. In  addition, medicines for hepatitis B may be needed. These are usually medicines  taken once daily by mouth.
How do doctors treat the complications of hepatitis D?
If chronic hepatitis D leads to cirrhosis, you should see a doctor who specializes in liver diseases. Doctors can treat health problems related to cirrhosis with medicines, surgery, and other medical procedures. If you have cirrhosis, you have a greater chance of developing liver cancer. Your doctor may order an ultrasound or other type of imaging test to check for liver cancer.
If acute hepatitis D leads to acute liver failure, or if chronic hepatitis D leads to liver failure or liver cancer, you may need a liver transplant.
How can I protect myself from hepatitis D infection?
If you do not have hepatitis B, you can prevent hepatitis D infection by taking steps to prevent hepatitis B infection, such as getting the hepatitis B vaccine. If you do not get hepatitis B, you cannot get hepatitis D.
If you already have hepatitis B, you can take steps to  prevent hepatitis D infection by
not sharing drug  needles or other drug materials
    wearing gloves if  you have to touch another person’s blood or open sores
    not sharing  personal items such as toothbrushes, razors, or nail clippersHow can I prevent spreading hepatitis D to others?
If you have hepatitis D, follow the steps above to avoid spreading the infection. Your sex partners should get a hepatitis B test and, if they aren’t infected, get the hepatitis B vaccine. Preventing hepatitis B will also prevent hepatitis D.
You can protect others from getting infected by telling your doctor, dentist, and other health care professionals that you have hepatitis D. Don’t donate blood or blood products, semen, organs, or tissue.
Is a hepatitis D vaccine available?
No vaccine for hepatitis D is currently available. The hepatitis B vaccine can prevent hepatitis D by preventing hepatitis B.
Eating, diet, and nutrition for hepatitis D
If you have hepatitis D, you should eat a balanced, healthy diet. Talk with your doctor about healthy eating. You should also avoid alcohol because it can cause more liver damage.
References
[19] Farci P, Niro GA. Clinical features of hepatitis D. *Seminars in Liver Disease*. 2012;32(3):228‒236.
[20] Ahn J, Gish RG. Hepatitis D virus: a call to screening. *Gastroenterology & Hepatology*. 2014;10(10):647‒686.
[21] Roy PK. Hepatitis D. Medscape website. http://emedicine.medscape.com/article/178038-overview. Updated March 16, 2017. Accessed June 5, 2017.
[22] Rizzetto M. Hepatitis D virus: introduction and epidemiology. *Cold Spring Harbor Perspectives in Medicine*. 2015;5(7):a021576.
[23] Hoofnagle JH. Type D (Delta) hepatitis. *Journal of the American Medical Association*. 1989;261(9):1321–1325.
[24] Negro F, Lok ASF. Pathogenesis, epidemiology, natural history, and clinical manifestations of hepatitis D virus infection. UpToDate website. http://www.uptodate.com/contents/pathogenesis-epidemiology-natural-history-and-clinical-manifestations-of-hepatitis-d-virus-infection. Updated July 20, 2016. Accessed June 5, 2017.        Last Reviewed May 2017
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                Hepatitis E

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