Hepatitis D Virus 1

Hepatitis D Virus (HDV) or delta virus is a unique incomplete virus that requires hepatitis B virus (HBV) for its replication. The RNA genome is covered by an outer coat of hepatitis B surface antigen. HDV infection occurs worldwide but is endemic in certain regions including the Mediterranean basin, the Balkan peninsula, the former Soviet Union, parts of Africa and the Middle East and the Amazon basin of South America. In these regions, spread is typically intrafamilial and through sexual contact.

In non-endemic regions, such as North America, HDV infection is uncommon in the general population but does occur in intravenous drug users and persons with frequent exposure to blood products (e.g. hemophiliacs) as well as their sexual contacts.

The clinical course of HDV infection depends largely on whether the virus was acquired as a coinfection with hepatitis B or as a superinfection in an individual with a previously established chronic HDV infection. When acquired as a coinfection, HDV typically results in acute self-limited hepatitis although fulminant hepatitis and death are well described. As a superinfection the typical course is one of a rapidly progressive chronic hepatitis.

Prevention of HDV infection is based on HDV vaccination in susceptible individuals. Patients with chronic HDV infection at risk of HDV infection are advised to avoid parenteral and unprotected sexual exposures.

The epidemiology of HAV is that of an enterically transmitted infection. The virus has a worldwide distribution but the prevalence of antibodies to HAV (signifying previous infection and immunity) varies widely between developing and developed countries and between different socioeconomic classes in individual countries. Typically, in developing countries more than 90% of the population is infected with HAV in childhood. Most HAV infections acquired in childhood are subclinical and anicteric, yet antibodies to the virus persist for life and provide immunity to further infection. Adult acquired infections are likely to be symptomatic and over the age of 40 are associated with a case-fatality rate of over 1%.

Paradoxically, with improved sanitation in developing regions, HAV infection is being delayed until adulthood and large symptomatic epidemics are increasingly being described. In 1988, an outbreak of HAV occurred in Shanghai, China with over 310,000 symptomatic cases reported – particularly in young adults between ages 20 and 40.

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