Hepatitis d: causes, symptoms, treatment, etc. & bull; hello healthy

Definition

What is hepatitis D?

Hepatitis D (HDV) or hepatitis delta is an inflammatory liver disease caused by delta virus infection. Inflammation of the liver can cause swelling that can affect how the liver works.

Compared to other hepatitis diseases, HDV is one of the most dangerous viral infections.

The reason is, this disease can attack hepatitis B (HBV) patients. This is because HDV is a type of RNA virus that is not yet perfect, so it requires HBV as a host to replicate.

If HDV and HBV occur together, of course you will experience a number of serious liver dysfunction. This is especially true if the hepatitis B infection has been going on for a long time, aka chronic.

Due to the limited choice of treatment, hepatitis D has a high risk of causing a number of complications. That is why it is important to prevent this disease from being carried out to avoid the dangers it causes.

How common is this condition?

Hepatitis D was first discovered in 1977 and since then there have been more than 10 million people of all ages who have been infected with this virus.

This disease is spread in various regions of the world with the highest number of cases in South Africa. In Indonesia alone, hepatitis D is rarely found.

Reporting from WHO, it is estimated that there are 15-20 million people in the world who become carriers (carrier) HBV infected with HDV.

Even so, the overall number of people with hepatitis D has decreased thanks to the hepatitis B vaccine program as a way to prevent transmission of this disease.

Type

The virus that causes hepatitis D is a pathogen composed of HDV RNA and hepatitis delta antigen (HDAg). In this type of hepatitis virus there are at least 8 types of genotypes that have been found.

HDV genotype 1 is the type of virus that is most often claimed to cause hepatitis D in the world, including in Southeast Asia. Even so, the characteristics of this delta virus are quite different from other hepatitis.

The delta virus can only hitch a ride on hepatitis B to replicate. This means that HDV will only actively infect after HBV has passed its incubation period. This is what makes hepatitis D divided into two types of infection, namely co-infection and superinfection.

Co-infection

Co-infection occurs when delta virus infection occurs simultaneously with HBV infection that is still in its acute phase (less than 6 months). Health problems that arise due to co-infection vary and are moderate to severe.

Co-infections can subside on their own without the help of medication. However, there is a possibility that the co-infection will develop into serious liver disease, namely fulminant hepatitis.

Superinfection

It is different with people who have been infected with chronic hepatitis B and then contracted hepatitis D, the replication of these two viruses will cause superinfection.

Generally, superinfection produces quite severe symptoms in a short time. This infection also exacerbates the hepatitis B symptoms that first appeared.

Superinfection will accelerate the progression of the disease causing a number of complications such as cirrhosis and liver cancer.

Complications

If the hepatitis D virus infection has been going on for a long time or is in a chronic phase, you may be at risk for fibrosis and complications, such as:

cirrhosis of the liver,
carcinoma, and
heart failure.

Complications can be characterized by an increase in the amount of scar tissue in the liver which also indicates that most of the liver cells have been damaged.

Liver cell damage can cause the liver to no longer be able to work.

For example, the liver is no longer working to produce bile to digest food, neutralize toxic substances, and regulate the circulation of hormones in the body.

Signs and symptoms

Generally, the symptoms of hepatitis D are not much different from the symptoms of hepatitis B, especially those that arise as a result of co-infection. The period of onset of symptoms usually lasts 2 - 8 weeks after infection.

Symptoms of co-infection

Common symptoms of delta virus infection include:

loss of appetite,
nausea and vomiting,
fatigue,
pain in the liver (on the right side of the stomach),
muscle and joint pain, and
yellowing of the skin and lining of the eyes (jaundice).

Superinfection symptoms

Meanwhile, the symptoms of HDV due to superinfection include:

jaundice (jaundice),
fatigue,
nausea and vomiting,
stomach pain,
itching of the skin,
decreased concentration,
often sleepy,
experiencing changes in behavior,
dark urine color,
change the color of the stool to become pale,
easy to experience bleeding and bruising, as well
swelling of the stomach due to ascites.

Transmission and risk factors

How is the disease transmitted?

HDV is only found in blood and body fluids such as sperm, vaginal fluids, and saliva.

The delta virus will enter the liver when blood or body fluids contaminated with this virus enter the body's tissues through blood vessels or sexual contact.

There are several things that are ways of transmitting the hepatitis D virus as follows.

Use of non-sterile syringes.
The use of needles for tattoos and piercings that are shared.
Blood transfusion process.
Having sex without contraception.
During the delivery process from mother to baby.
Use of medical equipment contaminated with the virus.
Use of household items contaminated with the patient's blood.

In addition, the delta virus on blood marks that stick to the equipment can also be a medium of transmission. This is because the virus can enter blood vessels through open wounds, both on the surface of the skin and bleeding gums.

What factors increase the risk of developing this condition?

The people most at risk of getting delta virus infection are people infected with hepatitis B. Even so, there are several conditions that make the risk of being exposed to the delta virus increase, namely as follows.

Have sex with someone with hepatitis D or B.
Having sex with more than one person without contraception.
Perform regular blood transfusions.
Use of syringes and other injection cancellation together.
Visiting areas experiencing hepatitis D outbreaks.
History of kidney disease, HIV infection, or diabetes.

Treatment

Until now, there is no specific drug to treat hepatitis D. However, it is believed that the following treatments can be used to inhibit the progression of the disease.

Pegylated interferon alpha

One way to deal with delta virus infection is to use high doses of interferon alpha injection 3 times a week. This treatment usually lasts 1-2 years, depending on the progress of the disease.

Interferon alpha injection works by restoring normal levels of body enzymes. This drug also helps to eliminate 70% of the delta virus in the body.

In addition, this hepatitis treatment also helps inhibit disease progression to prevent complications, such as cirrhosis and liver cancer.

Pegylated interferon alpha is not able to reduce viral load quickly. That is why, this treatment method takes time for all viruses in the body to die.

Prevention

So far, there is no specific vaccine to prevent hepatitis D. However, you can still reduce the risk of exposure to the delta virus with the hepatitis B vaccine. Even so, the vaccine will only be effective in people who have never been infected with the hepatitis B virus.

Fortunately, there are other ways you can do to avoid various factors that can increase your risk of experiencing this condition as below.

Have safe sex with someone with hepatitis.
Using sterile needles, especially while undergoing treatment.
Avoid sharing razors, toothbrushes and shavers with other people.
Wash your hands regularly, especially after coming in direct contact with blood.
Use protection or gloves for health workers.

If you have further questions, please contact your doctor to get the right solution.