Hepatitis D Diagnostics

Hepatitis is an inflammation of the liver. This is mainly transmitted by various viruses such as the hepatitis A, B or C virus.
The hepatitis D virus belongs to the group of RNA viruses. It requires the envelope of the hepatitis B virus for infection. Hepatitis D thus always occurs together with hepatitis B.

Transmission of the pathogen (route of infection) occurs parenterally through sexual intercourse, blood (via infusions/transfusions), and perinatally (around birth or during childbirth) from the mother to the unborn/newborn.

High-risk groups include medical personnel, drug addicts, and homosexuals.

Approximately five percent of those infected with hepatitis B are also infected with the hepatitis D virus. There are also regions (Brazil and Romania) where about 40% of hepatitis B infected persons are co-infected with hepatitis D.

When hepatitis D virus (HDV) infection is suspected, the following laboratory tests should be performed:

  • Serology – detection of hepatitis D-specific antigens (persists only briefly; 1-2nd week of acute infection; in superinfection)* .
    • Anti-HDV antibody
      • Anti-HDVIgM ELISA (serum): often the only marker during the lateAcute stage (hepatitis D antigen already negative); persistence is often observed during the chronic course.
      • Anti-HDVIgG ELISA (serum): often replaces the IgM antibody and persists only briefly during healing.
  • HDV RNA (if anti-HDV antibody is positive; RT-PCR): hepatitis D-PCR (EDTA blood) has the highest sensitivity in fresh (seronegative) infections.
  • Serology – detection of hepatitis B-specific antigens* .
    • Hepatitis B surface antigen (HBsAg).
    • Hepatitis B core antigen (HBcAg)
    • Hepatitis B e antigen (HBeAg)
    • IgM and IgG antibodies (anti-HBs, anti-HBc, anti-HBe).
  • Alanine aminotransferase (ALT, GPT), aspartate aminotransferase (AST, GOT), glutamate dehydrogenase (GLDH), and gamma-glutamyl transferase (γ-GT, gamma-GT; GGT).

* Direct or indirect detection must be reported by name if the evidence indicates acute infection (Law on Prevention and Control of Infectious Diseases in Humans).

Testing for HDV should be performed in all persons who have newly diagnosed HBV infection; this should also be followed up in those with known HBV and untested HDV.

The procedure

Material needed

  • Blood serum (hepatitis D antigen, anti-HDV IgM, anti-HDV IgG).
  • EDTA blood (HDV-PCR)

Preparation of the patient

  • Not known

Disruptive factors

  • Not known

Standard values

Parameter Standard values
Hepatitis D antigen Negative
Anti-HDV IgM Negative
Anti-HDV IgG Negative
Hepatitis D PCR Negative

Indications

  • Suspected hepatitis D infection
  • Therapy monitoring

Interpretation

Interpretation of increased values

  • Hepatitis D

Interpretation of decreased values

  • Not relevant to the disease

Further notes

  • Without hepatitis B infection is not possible hepatitis D infection
  • Suspicion of, illness from, and death from hepatitis are reportable
  • Infection with hepatitis B is more severe if there is co-infection with hepatitis D.