Current RMA Instruments
| 71 of 2025 | |
|---|---|
| 72 of 2025 |
Changes from previous Instruments
ICD Coding
- ICD-10-AM Codes: B16.0, B16.1, B 18.0
Brief description
Hepatitis D is a viral infection of the liver that can only occur in the presence of hepatitis B virus (HBV) infection. It may arise simultaneously with HBV (superinfection). Persistence of hepatitis D virus (HDV) infection depends on continued 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.
General practitioners may suspect the diagnosis clinically and order initial investigations, especially in someone known to have hepatitis B infection. However, specialist referral to an Infectious Diseases Physician or Gastroenterologist is generally required.
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 and D co-infection is clinically indistinguishable from acute hepatitis B virus (HBV) infection alone. Clinical onset of co-infection coincides with the onset of HBV infection. Confirmation requires evidence of acute HBV infection (see CLIK SOP advice for hepatitis B) together with contemporaneous laboratory evidence of hepatitis D virus (HDV) infection. Anti-HDV antibody typically becomes detectable around four weeks after acute HDV infection.
Superinfection with HDV may present as severe acute hepatitis in an unrecognized HBV carrier or as an exacerbation of established chronic Hepatitis B. Clinical onset can be dated from the appearance of manifestations once HDV infection has been confirmed. Documented anti-HDV seroconversion (from negative to positive) may be the only practical method of confirming the timing of acute HDV superinfection.
Clinical worsening
The natural course ranges from resolution (if HBV infection clears), to an asymptomatic carrier state, through to fulminant liver failure. An inability to obtain appropriate management for hepatitis D infection can result in clinical worsening. However, there is no current specific antiviral therapy for Hepatitis D infection.