These patients will more rapidly progress onto cirrhosis and may develop hepatocellular carcinoma. However, children from underdeveloped, HDV-endemic countries are more likely to contract HDV through breaks in the skin due to the presence of skin lesions. It is clinically indistinguishable from other forms of viral hepatitis. The incubation period is 21-45 days but may be shorter in cases of superinfection. Risk factors include intravenous drug use and multiple blood transfusions.
Perinatal transmission is rare.
HBsAg is required for HDV replication but may be suppressed to undetectable levels with active HDV replication. Right upper quadrant ultrasound to evaluate for biliary obstruction, and also to evaluate for hepatocellular carcinoma. In patients with chronic liver disease, it is indicated to evaluate for the presence of fibrosis and cirrhosis. HDV Ag immunohistochemical analysis of liver tissue is the gold standard for establishing diagnosis of persistent HDV infection. Immunohistochemical staining for HDV Ag is positive.