Date amended:
Statements of Principles
Current RMA Instruments
Reasonable Hypothesis SOP
11 of 2017
Balance of Probabilities SOP
12 of 2017
Changes from previous Instruments

 ICD Coding
  • ICD-9-CM Codes:  070.42, 070.52
  • ICD-10-AM Codes: B17.0
Brief description

Hepatitis D is a viral infection of the liver.  The infection requires and always occurs in conjunction with Hepatitis B virus (HBV) infection.  Onset may be at the same time as that of the HBV (co-infection) or occur later (superinfection).  Persistence of Hepatitis D virus (HDV) infection is dependent upon persistence of HBV infection.

Confirming the diagnosis

The diagnosis of Hepatitis D requires: confirmation of the presence of Hepatitis B infection, usually from serology positive for HBsAg; and, the presence of Hepatitis D virus antibodies (anti-HDV) or Hepatitis D virus ribonucleic acid (HDV RNA) on laboratory testing.

The relevant medical specialist is a gastroenterologist or hepatologist. 

Additional diagnoses covered by SOP
  • Delta virus infection
Conditions not covered by SOP
  • Hepatitis A*
  • Hepatitis B*
  • Hepatitis C*
  • Hepatitis E*

* Another SOP applies

Clinical onset

Acute Hepatitis B + D co-infection is clinically indistinguishable from Hepatitis B virus infection alone.  Clinical onset of co-infection will be at the time of onset of HBV infection.  Evidence of acute HBV infection (see CLIK SOP information for Hepatits B) and contemporary positive laboratory evidence of HDV infection will be required to confirm co-infection (note: anti-HDV antibody is usually detectable after approxiamtely four weeks of acute infection with Hepatitis D).

Superinfection with Hepatitis D may manifest as a severe acute hepatitis in a previously unrecognized HBV carrier, or as an exacerbation of preexisting chronic Hepatitis B.  Clinical onset can be based on the timing of clinical manifestations, once HDV infection has been confirmed.  Documented anti-HDV seroconversion (from negative to positive) may be the only practical way to confirm the timing of acute HDV superinfection.

Clinical worsening

The natural course of the condition ranges from resolution (if HBV infection resolves), though asymptomatic carrier state, to fulminant liver failure.  There is no current specific treatment for Hepatitis D infection.