Hepatitis D

Overview

Hepatitis D is a liver infection caused by the hepatitis D virus. It is also called delta hepatitis. It can only infect someone who also has hepatitis B, because the hepatitis D virus needs the hepatitis B virus to survive and multiply. This means hepatitis D is always linked to hepatitis B.

Hepatitis D is uncommon in many parts of the world, but how common it is varies widely by region and among groups of people. It is more common in some areas and in people who are not vaccinated against hepatitis B.

It affects people who already have hepatitis B, especially those who are not vaccinated, people who inject drugs, and people exposed to blood or body fluids through unsafe medical or personal practices. It can affect adults and children.

Symptoms

Common symptoms

• No symptoms at all (this is common)
• Feeling very tired
• Nausea, vomiting, or loss of appetite
• Pain or discomfort under the ribs on the right side
• Yellowing of the skin and eyes (jaundice)
• Dark urine or pale stools
• Joint pain
• Fever

Symptoms in children

• Children often have no symptoms or very mild illness.
• When symptoms happen, they may include tiredness, poor appetite, nausea, or yellowing of the skin and eyes.
• Children with hepatitis B should still be checked for hepatitis D.

Symptoms in older adults

• Older adults may be more likely to become seriously unwell, especially if they already have liver damage.
• They may have more tiredness, confusion if liver function drops, or a slower recovery.

Causes

Main causes

• Infection with the hepatitis D virus. It only happens in people who also have hepatitis B.
• The virus spreads through contact with infected blood or body fluids.
• It can be passed through sharing needles or other drug equipment, unsterile tattoos or piercings, needlestick injuries, sex without protection, or from a mother to baby (less common).
• It is not spread by hugging, sharing food, or casual contact.

Risk factors

• Having hepatitis B
• Not being vaccinated against hepatitis B
• Injecting drugs and sharing needles or equipment
• Receiving blood or medical care in places where equipment is not properly sterilised
• Birth in or travel to areas where hepatitis B or D is common
• Close household contact with someone who has hepatitis B
• Sex without condoms
• Healthcare work with possible exposure to blood

When to see a doctor

See a doctor urgently if:

• You have new yellowing of the skin or eyes.
• You have severe abdominal pain, vomiting blood, black stools, or bleeding that will not stop.
• You feel very confused, very drowsy, or unable to keep fluids down.
• You have swelling of the abdomen or legs.

Book a routine appointment if:

• You have hepatitis B and have not been tested for hepatitis D.
• You think you may have been exposed to hepatitis B or D.
• You have ongoing tiredness or abnormal liver blood tests.
• You want to check whether you are vaccinated against hepatitis B.

Diagnosis

A doctor uses blood tests to look for hepatitis D virus and signs of hepatitis B. They will also check how well your liver is working and whether there is liver damage.

Tests that may be done

• Blood tests for hepatitis D antibodies and hepatitis D virus genetic material (RNA)
• Blood tests for hepatitis B
• Liver function blood tests
• Imaging such as ultrasound or a special scan to check liver stiffness
• Sometimes a small liver sample (biopsy), but this is not always needed

What to expect at your appointment

You may need repeat blood tests and a referral to a liver specialist. Results can take days to weeks. Your doctor will explain what the tests show and what monitoring you need.

Treatment

There is no simple cure for hepatitis D. Treatment focuses on protecting the liver, treating hepatitis B if needed, and watching for liver damage. Some people need specialist medicines, and a small number need a liver transplant if the liver fails.

Self-care at home

• Rest and drink enough fluids, especially when you feel unwell.
• Avoid alcohol completely.
• Do not share razors, toothbrushes, nail clippers, or needles.
• Check with your doctor or pharmacist before taking any medicine, supplement, or herbal product.
• Eat a balanced diet and stay physically active as your energy allows.
• Keep vaccinations up to date as advised by your care team.

Medical treatments

Specialist doctors may use antiviral or immune-based medicines in some cases. These are not suitable for everyone and must be prescribed by a liver specialist. Treatment aims to reduce virus activity and liver damage. People with advanced liver disease may be considered for a liver transplant.

When is surgery considered?

Surgery is not used to cure hepatitis D. A liver transplant, which is a type of surgery, may be an option for people whose liver has failed or has severe complications.

Living with this condition

Living with hepatitis D usually means regular check-ups, blood tests, and looking after your liver. Your care team will watch for changes and help you manage symptoms. Keep a list of your medicines and ask before taking anything new.

Lifestyle tips

• Avoid alcohol completely.
• Do not share needles, razors, toothbrushes, or nail clippers.
• Use condoms or another barrier method if advised.
• Tell healthcare workers you have hepatitis B and D before procedures.
• Get vaccinated against hepatitis A and B if not already, and follow local advice.
• Eat a balanced diet and stay physically active.

Diet and exercise

A balanced diet with plenty of vegetables, fruit, whole grains, and lean protein can help. Avoid fad diets and high-dose supplements. Gentle regular exercise is helpful. Ask your care team what is safe if you have advanced liver disease.

Mental health and emotional wellbeing

It is normal to feel worried, tired, or isolated. Hepatitis D can affect mood and daily life. Talk to your doctor if you feel anxious or low. If you are in crisis or thinking of harming yourself, contact your local emergency services or a local crisis support service right away.

Prevention

Yes. Hepatitis D can be prevented by preventing hepatitis B. If you are protected from hepatitis B, you cannot get hepatitis D. Good hygiene and safer blood practices also lower risk.

Vaccines

Hepatitis B vaccination is the main protection. It is recommended for babies and many groups at higher risk. There is no separate routine hepatitis D vaccine. If you are unsure whether you are vaccinated, ask your doctor or pharmacist.

Screening programmes

People with hepatitis B should be tested for hepatitis D, especially if they have liver damage or are from an area where hepatitis D is common. Pregnant women and people at risk should be offered hepatitis B testing as part of local care.

Complications

If left untreated

• Scarring of the liver (cirrhosis)
• Liver failure
• Liver cancer
• Bleeding from the gut or fluid in the abdomen when liver disease is advanced
• Serious illness when hepatitis D is added to existing hepatitis B (superinfection)

Long-term outlook

Many people with hepatitis D can live for years with careful monitoring and treatment. Some people improve, while others develop liver damage over time. Regular specialist care, avoiding alcohol, and preventing hepatitis B for others are important. New treatments are being studied, so there is reason for hope.

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