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Hepatitis D: CDC Viral Hepatitis Serology Training

December 16, 2019

– Delta Hepatitis caused
by infection with the Hepatitis Delta Virus, referred to as HDV, is not seen commonly in the United States. Because HDV requires HBV for replication it can only infect someone at the same time as HBV, called co-infection. Or infect someone who has chronic HBV infection,
called Superinfection. If detected, it is usually in the context of a Hepatitis B outbreak or, perhaps, when a patient with Acute Hepatitis B has a more severe clinical
course than expected. HDV and HBV co-infection occurs when a person becomes infected with both viruses at the same time. Evidence of Acute Hepatitis B is depicted by the red-hatch line,
denoting Hepatitis B Surface Antigen, or HBsAg positivity. The blue-hatch line,
total anti-HBc positivity and IgM anti-HBc
positivity, shown in yellow. Total antibody to HDV,
referred to as anti-HDV, shown by the green bar is detectable during the course of infection in about 85% of co-infections. Total anti-HDV generally declines to undetectable levels after
the infection resolves, as reflected by the rise of antibody to Hepatitis B Surface Antigen, anti-HBs, depicted by the orange-hatch line. There is no serologic
marker that persists to indicate that the patient
was ever infected with HDV. Total anti-HBc and
anti-HBs remain positive and denote immunity to future infection with both HBV and HDV. Patients with co-infection develop chronic infection less frequently than those with HBV infection alone, about 2% compared with from 2%-6% of adults infected with HBV alone. If HDV infects a person
with chronic HBV infection, as depicted by HBsAg in
red and total HBc in blue, it is called Superinfection,
and most persons will remain chronically infected with both viruses and
often experience more severe exacerbations
of their liver disease. Total anti-HDV, total HBC and HBsAg persist indefinitely in these patients. Although there are commercially available assays for detection of anti-HDV and some state laboratories
use these for testing, none are FDA approved
in the United States. Nucleic Acid Tests, NATS,
for detection of Viremia are used in some research laboratories, as well as at CDC, but are
not commercially available. This segment is now complete.

1 Comment

  • Reply Fezzz1 February 3, 2018 at 5:39 am

    Thank goodness that HepD isn't very common… I can't believe anti-HDV assays are not FDA approved PLUS that NATS for viremia aren't commercially available. I still can't believe we can't store and keep our own Rabies injections for whenever we want. What a load of horse manure.

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