Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:12

Hepatitis Delta Virus 693

Hepatitis Delta Virus..................................

JEFFREY S. GLENN, MD, PhD

history & physical

■“Parasite virus” of HBV

■HDV has own genome and coat protein; requires HBV to provide

envelope; therefore, always found in association with HBV infection

History

■same as for HBV (although different areas of predominant endemic-

ity)

■two clinical scenarios (requires high index of suspicion for dia-

gnosis):

■coinfection-simultaneous with acute HBV infection-of previously

uninfected patient

■superinfection-HDV infection of chronically-infected HBV patient-

manifested by sudden worsening/ “flare” of previously stable chro-

nic HBV carrier

■clinical course characteristically more severe than for HBV infection

alone

tests

Laboratory

■same as for HBV

■in addition, anti-HD IgM-best for diagnosis of acute infection

■anti-HD IgG develops late; often transiently; low titer in acute infec-

tion

■HDV RNA-reliable marker for acute and chronic infection

■HDAg–reliable marker for acute and chronic infection in serum and

liver biopsy

■HBV markers of replication often suppressed upon acute HDV infec-

tion

differential diagnosis

■Same as for HBV

management

■Same as for HBV

specific therapy

■No proven effective specific anti-HDV therapy