Hepatitis D: features, diagnosis, and prognosis
Definition of Hepatitis D
Hepatitis D, also known as delta hepatitis, is a viral inflammatory disease of the liver caused by the hepatitis D virus (HDV). This virus has the ability to infect liver cells only in the presence of the hepatitis B virus (HBV), making it dependent on the availability of this auxiliary virus for its replication. Hepatitis D is characterized by a severe course of the disease and a high risk of complications, such as liver cirrhosis and hepatocellular carcinoma. Effective vaccination against hepatitis B plays a key role in the prevention of hepatitis D.
Etiology of Hepatitis D
Hepatitis D is caused by the hepatitis D virus (or delta virus), which is a defective virus and cannot replicate on its own. This virus requires the presence of the hepatitis B virus (HBV) for its reproduction. Transmission of the hepatitis D virus occurs through blood or other infected fluids during intravenous drug use, sexual contact, or vertically from mother to child during childbirth.
The delta virus directly infects the liver hepatocytes, causing inflammation that can lead to acute or chronic hepatitis. Therefore, the main causes of hepatitis D development are associated with contact with infected blood or other fluids, as well as irregular sexual partnerships with an infected partner or vertical transmission from an infected mother.
- Delta virus: Hepatitis D is caused by the delta virus, which requires the presence of the hepatitis B virus for replication.
- Blood transmission: The primary mode of transmission of the virus is contact with infected blood, for instance, through injection drug use.
- Sexual contact: The risk of infection increases with sexual contact with an infected partner.
- Vertical transmission: The virus can be transmitted from an infected mother to her child during childbirth or earlier.
- Hygiene violations: Inadequate adherence to hygiene or the use of contaminated medical instruments can also facilitate the transmission of hepatitis D.
Clinical picture of Hepatitis D
Hepatitis D can manifest as both an acute and a chronic form of the disease. In the acute phase, patients may experience general symptoms of intoxication, such as fatigue, loss of appetite, nausea, vomiting, abdominal pain, jaundice, as well as intensified skin itching. Many patients may also have an enlarged liver and spleen, indicating damage to these organs due to inflammation.
In the chronic form of the disease, symptoms may be less pronounced, but patients may periodically experience fatigue, weakness, weight loss, and other signs of liver dysfunction. In some patients, chronic hepatitis D can progress to liver cirrhosis or hepatocellular carcinoma.
- General symptoms of intoxication: include fatigue, loss of appetite, nausea, vomiting, and abdominal pain due to the effects of toxins on the body.
- Jaundice: is manifested by yellowing of the skin and sclera, caused by elevated levels of bilirubin in the blood.
- Enlarged liver and spleen: indicate damage to these organs due to inflammation, which may be noticeable upon physical examination of the patient.
- Intensified skin itching: occurs due to impaired bile secretion in the liver and accumulation of bile acids in the blood.
- Fatigue and weakness: patients often experience tiredness, which may be related to metabolic disturbances and the overall toxic impact on the body.
Expert opinions on the treatment of Hepatitis D
The treatment of hepatitis D requires a comprehensive approach, which often includes the use of antiviral medications such as interferons that can help suppress viral activity and slow disease progression. Experts also recommend the use of RNA polymerase inhibitors, such as lamivudine, to combat the replication of the hepatitis D virus.
In addition to pharmacological methods, specialists recognize that an important component of hepatitis D treatment is maintaining a healthy lifestyle. This includes proper nutrition, abstaining from alcohol and nicotine, regular physical activity, as well as following all the doctor’s recommendations. Experts also recommend preventive vaccination against hepatitis B, as hepatitis D infection is only possible in the presence of the hepatitis B virus.
Diagnosis of Hepatitis D
The diagnosis of hepatitis D usually involves various methods aimed at detecting the delta virus in the patient’s blood. This process typically begins with blood tests to detect antibodies to the hepatitis D virus, as well as the virus’s antigens. Further diagnostic methods may include molecular tests such as polymerase chain reaction (PCR) to identify the genetic material of the virus.
In addition to laboratory tests, the doctor may recommend liver examinations such as ultrasound, computed tomography, or magnetic resonance imaging to assess the extent of liver damage and rule out other possible causes of its impairment. The diagnosis of hepatitis D also includes assessing the activity level of the inflammatory process and liver fibrosis, which helps choose the right treatment approach and establish the disease’s prognosis.
- Laboratory tests: Include the detection of antibodies and antigens of hepatitis D virus in the blood via various immunological methods.
- Molecular tests: Include PCR to identify the genetic material of the delta agent virus in the patient’s body.
- Liver examination: Includes ultrasound, computed tomography, or magnetic resonance imaging to assess the condition of the liver and rule out other pathologies.
- Assessment of inflammation activity: Used to determine the degree of liver inflammation and assess the activity of the disease process.
- Assessment of liver fibrosis: Allows determining the degree of fibrosis (scarring) in the liver, which is important for choosing optimal treatment and disease prognosis.
Treatment of Hepatitis D
Treatment of hepatitis D often presents a challenge due to the limited number of drugs available to combat this virus. However, the standard approach to treating hepatitis D is combination therapy using interferon-alpha and the nucleoside analog lamivudine. These drugs can help rein in the virus and prevent its multiplication in the body.
More recently, new drugs, such as DNA polymerase inhibitors and inhibitors of hepatitis D virus replication, have been developed that represent reliable treatment methods and contribute to long-term health improvement for patients. For chronic hepatitis D, treatment of complications such as cirrhosis or hepatocellular carcinoma may also be required, highlighting the importance of timely diagnosis and appropriate therapy.
- Combined therapy using interferon-alpha and the nucleoside analogue lamivudine is often used to suppress hepatitis D virus and prevent its reproduction in the body.
- DNA polymerase inhibitors and hepatitis D virus replication inhibitors are new drugs that have proven effective in treating this disease and contribute to the improvement of patients’ conditions.
- Great attention in the treatment of chronic hepatitis D is also paid to managing complications such as liver cirrhosis and hepatocellular carcinoma.
- In some cases, liver transplantation may be required in the development of liver failure due to chronic hepatitis D.
- Patients with hepatitis D are often also prescribed supportive treatment measures, including diet, abstinence from alcohol, and regular medical monitoring to control the disease’s condition.
Prevention of Hepatitis D
The prevention of hepatitis D includes several key measures aimed at preventing infection with the virus. One important prevention strategy is vaccination against hepatitis B, as the hepatitis D virus requires the presence of the hepatitis B virus for its replication. Therefore, mandatory vaccination against hepatitis B can prevent infection with the delta virus.
Additional preventive measures for hepatitis D include adhering to sanitary and hygienic norms, avoiding skin damage and contact with bodily fluids of infected individuals, using protective condoms during sexual intercourse, as well as avoiding the use of injectable drugs. Early detection and treatment of hepatitis B, along with a healthy lifestyle, contribute to the prevention of hepatitis D and reduce the risk of infection with this virus.
- Vaccination against hepatitis B: since the hepatitis D virus requires the presence of the hepatitis B virus for its reproduction, vaccination against hepatitis B is an important part of hepatitis D prevention.
- Sanitary and hygienic measures: adherence to personal hygiene rules, regular handwashing, use of individual hygiene items, etc., helps prevent the spread of infection.
- Avoiding contact with blood: avoiding contact with blood or other infected bodily fluids helps reduce the likelihood of contracting the hepatitis D virus.
- Using condoms: using condoms during sexual contact helps prevent the transmission of the virus through sexual contact.
- Avoiding drug use: avoiding intravenous drug use and following safety measures during medical procedures helps prevent infection with hepatitis D.
Interesting facts about Hepatitis D
Hepatitis D is a special form of viral hepatitis caused by the delta virus. A distinctive feature of this virus is its inability to replicate independently, and it requires the presence of the hepatitis B virus for its life cycle. This dependency makes hepatitis D more complex compared to other forms of viral hepatitis and requires a specialized approach in diagnosis, treatment, and prevention.
An interesting feature of hepatitis D is its relative rarity compared to other forms of hepatitis. Although delta virus infection can be a serious illness, it occurs much less frequently than infections with hepatitis A, B, or C. Understanding the characteristics of hepatitis D will help improve the diagnosis and treatment of this disease, which is especially important for patients facing this virus.
FAQ
What are the ways of transmitting hepatitis D virus?
Hepatitis D virus is transmitted through contact with infected blood or other infected fluids, such as semen or vaginal secretions. The main modes of transmission of the virus include injection drug use, sexual contact, vertical transmission from mother to child during childbirth, as well as procedures related to medical practices that may involve violations of aseptic and antiseptic standards.
What treatment methods for hepatitis D are at the forefront of medical practice?
In frontline medical practice for the treatment of hepatitis D, innovative methods are used, such as DNA polymerase inhibitors and inhibitors of hepatitis D virus replication. These methods contribute to the suppression of viral activity and help patients achieve a sustained virological response to therapy. Thanks to modern pharmaceuticals and advanced techniques, there is an improvement in the treatment outcomes of hepatitis D, which opens up prospects for a more effective fight against this disease.
What factors increase the risk of developing chronic hepatitis D?
Chronic form of hepatitis D can develop in patients who have certain risk factors. These factors include late onset of infection, coexisting liver diseases, as well as the prolonged presence of the virus in the body. Additionally, patients with chronic hepatitis B who are also infected with hepatitis D virus are more likely to develop a chronic course of the disease.
What complications can arise from chronic hepatitis D?
In the chronic course of hepatitis D, various complications may arise, including cirrhosis of the liver, which is characterized by the gradual replacement of healthy liver tissue with connective tissue and disruption of its functions. Another complication may be the development of hepatocellular carcinoma, which represents liver cancer and is one of the serious complications of chronic liver inflammation. Such complications require additional medical intervention and can significantly affect the prognosis of the disease and the quality of life of the patient.