Clinical Features




Co-infection occurs when a person becomes infected simultaneously with HBV and HDV.  The most common outcome is complete recovery and clearance of both viruses.  In less than 5% of cases, patients develop chronic infections.  In about 1% of cases, infection results in fulminant hepatitis.


HBV-HDV Coinfection Serology (graph)



Super-infection occurs when a person who is already seropositive for HBV becomes infected with HDV.  It is associated with more severe clinical outcomes than co-infection with HDV.  Fulminant hepatitis develops in about 5% of cases.  80-90% of infections will become chronic, increasing the rate with which patients develop cirrhosis.  The chance of developing hepatocellular carcinoma (liver cancer) also increases.


HBV-HDV Superinfection Serology (graph)



As many as 90% of infected patients may be asymptomatic.  Common symptoms are jaundice, dark urine, abdominal pain, fever, and nausea with emesis.  Confusion, bruising, bleeding, and encephalopathy are rare.


Differential Diagnosis


HDV infection can be difficult to distinguish from other causes of hepatitis.  The differential diagnosis includes other viruses, other infectious causes, and some non-infectious causes.



Hepatitis A

Hepatitis B

Hepatitis C

Hepatitis E


Yellow fever




Infectious Causes:




Liver flukes


Non-infectious Causes:


Alcoholic hepatitis

Liver abcess

Biliary obstruction

Mushroom toxicity

Acetominophen poisoning

Drug-induced hepatitis



Laboratory Tests


--Serologic assays for HDV-RNA and δAg

--Antibody assays for anti-HDV IgM and IgG

--Imaging of upper right quadrant to check for biliary obstruction and hepatocellular carcinoma

--Immunohistochemical analysis of liver tissue in causes of suspected persistant HDV infection





There is currently no vaccine or immune globulin available for HDV.  Antiviral treatment consists of interferon alpha.  Antivirals such as lamivudine and ribavirin, which work against other forms of viral hepatitis, appear to be ineffective in treating HDV infection.