Chronic delta hepatitis, also known as hepatitis D, is a life-threatening disease caused by infection with the delta hepatitis virus (HDV).
But this virus has a peculiarity, and that is that it only infects when the patient is infected with another hepatitis virus, the hepatitis B virus. It is what experts call a ‘satellite’ virus.
In Spain, according to , 0.22% of the population has active hepatitis infection (close to 90,000 people). And of them, it is estimated that 5% are coinfected with VHD.
And the problem is that coinfection with HDV leads to more serious liver disease than hepatitis B alone, they explain from the .
What happens is that when the patient is infected by both viruses:
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The disease progresses more rapidly towards fibrosis
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Produces an increased risk of developing cirrhosis of the liver
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It causes higher rates of liver cancer and death.
How is hepatitis D transmitted?
As explained by , the transmission of this virus occurs through organic fluids or blood.
Therefore, the people most at risk of contracting the virus are people dependent on injection drugs and people who require a large number of blood transfusions, such as haemophiliacs.
Fortunately, in recent years the number of patients with this infection has been decreasing thanks to the tight control to which blood is subjected once donated, and the decrease in the number of drug addicts.
And there is one more issue that has made it possible to reduce these numbers, and it is vaccination against the hepatitis B virus, which is inoculated to children as soon as they are born.
Hepatitis D symptoms
FEAD digestive experts explain that the manifestations of hepatitis D can vary depending on whether the patient suffers coinfection either superinfection.
When the simultaneous infection of the hepatitis B and D viruses occurs, the most common symptoms are:
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Fatigue.
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loss of appetite
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Fever.
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Headache.
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Nausea.
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vomiting
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Jaundice (yellow pigmentation of the skin and mucous membranes).
In general, these patients evolve well and are cured, although around 5% become chronic with the disease.
When HDV infection affects a chronic hepatitis B patient, the FEAD refers to superinfection.
The symptoms are very similar to those of coinfection, but these cases “almost always progress to chronicity and with more rapid progression to end-stage liver disease.”
First registry of patients with VHD
It is believed that at least 12 million people worldwide have hepatitis delta, and many are undiagnosed.
This is due, in part, to limited knowledge of the disease and the historical lack of effective treatments. Factors that have impaired screening and historically led to high rates of underdiagnosis, as well as a diagnosis of the disease in late stages.
In order to give more visibility and expand the study of this liver pathology, the Spanish Association for the Study of the Liver (AEEH) has launched the first Registry of Patients with hepatitis D, which up to now includes 252 patients with an average of age 52 years.
After monitoring these patients for 6 years, the researchers drew the conclusion from this registry that the diagnosis of hepatitis occurs at an advanced stage, since half of the patients already had cirrhosis. Specific:
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45% of them already had cirrhosis
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19% had portal hypertension (increased blood pressure in the vein between the intestine and the liver)
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Only 4% had liver cancer.
During follow-up, however, an additional 11% and 15% developed cirrhosis and portal hypertension, respectively. In addition, 7% developed cancer and 15% required a liver transplant.
The researchers warn that “today there are barriers to the management of hepatitis D”, as evidenced by the fact that “in most centers it is not possible to determine the RNA-HDV”.
For this reason, the authors agree that this registry “can be used to monitor a large number of patients to better understand the infection, as well as make HDV-RNA determination available to other centers to improve its management.”