What is Hepatitis D?

Hepatitis D, which belongs to the group of liver diseases, is basically a notifiable, harmful disease caused by an infection. Hepatitis D is of great epidemiological importance. Specific microorganisms can trigger hepatitis D.

What is hepatitis D?

According to AbbreviationFinder.org, Hepatitis D is a liver disease that can occur in patients who already have contagious hepatitis B or are healthy.

The term hepa- means that the liver is severely affected by hepatitis D. The ending -itis’ shows that hepatitis D is mainly an inflammatory process.

Basically, hepatitis D leads to pathological and permanent damage to the liver cells, which are absolutely necessary for the metabolism in the body, due to special triggers. In Germany, however, hepatitis D is considered a disease that rarely occurs.


The causes of hepatitis D are easy to explain, because the results of scientific studies have shown that specific viruses can be the cause. Hepatitis D is about the pathogen known as the hepatitis D virus. This virus is derived from hepatitis B and is characterized by a protein on its cell surface, HBsAg.

For this reason, people in particular who have already been infected with a hepatitis B virus almost always become infected with hepatitis D. Healthy people can become infected through food intake and through transmission of the virus from sick people. This can occur through contact fluids such as semen, tears, the mother’s milk from breastfeeding, and saliva.

Blood and all other carrier media also get into the healthy organism through the mucous membranes or injuries and contribute to hepatitis D infection.

Symptoms, Ailments & Signs

Hepatitis D only occurs together with hepatitis B, since the HD virus needs the envelope protein of the HB virus to multiply. Symptoms are similar to those of HBV infection. However, the course and severity of the symptoms depend on whether the patient is infected with both viruses at the same time (simultaneous infection) or whether the HDV infection follows an HBV infection ( superinfection ).

In the case of simultaneous infection, chronic courses rarely occur because both viruses interfere with each other. However, the acute course of the disease can still be severe. As with an HBV infection, the simultaneous infection begins with unspecific symptoms such as tiredness, loss of appetite, exhaustion, headache, joint pain, fever and pressure in the upper right abdomen. Diarrhea, nausea and vomiting can also occur.

Jaundice is also common. The skin and eyes turn yellow with simultaneous decoloration of the stool and dark color of the urine. In most cases, hepatitis heals completely after a severe acute course of the disease if it is infected with both viruses at the same time.

However, if the HDV infection occurs after an HBV infection has almost been overcome, similar symptoms are observed, but these are usually even more severe. The infection then often progresses fulminantly to the point of fatal liver failure. At the same time, a chronic course with the development of liver cirrhosis and liver cancer is very common.


After a so-called incubation period, during which the virus multiplies, both chronic and acute signs of hepatitis D appear. Those affected who are infected with the hepatitis D virus tend to show non-specific symptoms that are similar to the flu and are expressed as exhaustion, tiredness, body aches and general discomfort.

In many cases, the skin and mucous membranes turn yellowish, and jaundice develops. About 90 percent of those infected with hepatitis D recover.

In addition to destruction of the liver and liver cancer, as well as severe impairment of the liver, those affected with hepatitis B suffer from constant episodes of fever and general weakness. In the majority of cases, the prognosis is very poor if hepatitis D, hepatitis B and a so-called superinfection are present at the same time.

If the patient is already suffering from hepatitis B, then infection with the typical hepatitis D pathogen will intensify the symptoms.


A single infection with the hepatitis D virus is not possible, a previous infection with the hepatitis B virus is a prerequisite. This means that infection with hepatitis D is relatively harmless. It becomes more dangerous if the person affected is infected with the hepatitis B and hepatitis D virus at the same time.

This greatly increases the likelihood of developing chronic hepatitis. It is even more dangerous when someone who already has hepatitis B becomes infected with the hepatitis D virus. This increases the risk of developing a chronic course and the likelihood of developing liver cirrhosis. Liver cirrhosis has a severe impact on quality of life.

The affected person is no longer able to synthesize proteins for the blood in sufficient quantities. In particular, these are proteins that maintain oncotic pressure and coagulation proteins. As a result, water retention can occur (edema) and the bleeding time is also prolonged.

Furthermore, the liver can no longer detoxify sufficiently, the cell toxin ammonia accumulates, which can lead to disorders and paralysis in the central nervous system (hepatic encephalopathy). The probability of developing liver cancer in the course of liver cirrhosis is greatly increased. Life expectancy is generally limited for those affected.

When should you go to the doctor?

Immediate medical examination is necessary for hepatitis D. This disease does not heal on its own and is usually fatal if the condition is not treated.

In addition to the symptoms, the person concerned should pay attention to whether they have been in an area affected by hepatitis D in the past few weeks and months. A visit to the doctor is necessary when jaundice occurs. Jaundice is the main symptom of all hepatitis diseases.

As a rule, high fever and tiredness or exhaustion also indicate hepatitis D and must be examined by a doctor. Those affected suffer from weight loss, severe abdominal pain and loss of appetite. If hepatitis D is not treated, the affected person’s liver is completely destroyed.

Diagnosis and treatment of hepatitis D can be done by a general practitioner or in a hospital. Since a direct and complete cure of the disease is not possible, the patients are usually dependent on long-term therapy.

Treatment & Therapy

Although hepatitis D is an extremely exhausting and protracted, dangerous disease that can be associated with serious health consequences, the therapeutic options are largely limited.

In addition, treatments are available to address the individual symptoms of hepatitis D. In principle, a one-year therapy with interferon can be implemented. In the case of hepatitis D, this can lead to the disease-causing virus being rendered harmless. However, this drug is considered controversial in relation to its effects on hepatitis D.

Hepatitis D is usually treated with the same methods that are indicated for hepatitis B. However, not all therapeutic measures are equally effective.

No medication can currently cure hepatitis D. Only painkillers to relieve the painful symptoms and medicines to treat nausea and vomiting are used in the treatment of hepatitis D.

Outlook & Forecast

Timely diagnosis is particularly important for the course of hepatitis D. Therefore, anyone who is suffering from acute or chronic hepatitis B should definitely also be examined for hepatitis D infection. The test is simple and can be performed with a simple blood test.

The course can often not be predicted with certainty, since the therapy of hepatitis D is very challenging. The virus-related, chronic inflammation of the liver can, however, be successfully treated today. For example, interferon therapy, as used to treat the B virus, is also effective for hepatitis D.

As it turned out, this preparation reduces the virus multiplication rate very significantly. However, the therapy is not always 100% effective. Often the infection reappears after a temporary stop. Therefore, after the end of therapy, relapses may occur. Sometimes these often only show up years after the treatment.

Hepatitis D can lead to severe liver damage, liver inflammation and even liver failure. This can be accompanied by a number of (sometimes serious) functional disorders of the organism. It is therefore particularly important to stop the progressive and ever increasing stress on the liver. Although interferon cannot permanently stop the progression of the disease, it does enable long, symptom-free phases.


Prevention against hepatitis D is particularly recommended when traveling to Mediterranean countries and other, mainly tropical and subtropical continents, or when there is increased contact with people who may be infected.

This applies to special professional groups. In this context, vaccination against hepatitis D is the only sensible precaution. In this regard, a preventive vaccination against hepatitis B with weakened pathogens is equally effective as hepatitis D prophylaxis.


In most cases, follow-up care for hepatitis D is relatively difficult. As a rule, the disease must first be treated comprehensively so that there are no further complications or a further deterioration of the symptoms. The earlier hepatitis D is detected, the better the further course of the disease.

The disease can only be treated purely symptomatically. The person concerned should always ensure strict bed rest in order not to exert the body unnecessarily. Physical or stressful activities should definitely be avoided. In many cases, medication can also be taken to relieve the symptoms of hepatitis D.

It is important to ensure that the dosage is correct and that these medications are taken regularly so that the symptoms can be alleviated. Regular examinations by an internist are also of great importance, whereby the liver of the person concerned should be examined in particular. During the treatment, the patient has to change his diet to light food in order to relieve the liver. Hepatitis D may also reduce the life expectancy of those affected.

You can do that yourself

An outbreak of hepatitis D must always be examined and treated by a doctor. A number of measures and remedies from the home and nature can be used to combat the individual symptoms.

A healthy and balanced diet with sufficient vitamins, minerals and trace elements is particularly essential. As a result, the immune system can quickly find its way back to its optimal performance. Patients should also drink plenty of water. Stimulants such as alcohol, nicotine or caffeine should be avoided as far as possible. Those affected should exercise regularly and recover from the disease with bed rest.

Various types of tea (e.g. milk thistle, yarrow, birch leaves), artichoke juice and baths with seed oat or essential oils can be used for liver problems. Soothing preparations such as marigold ointment or valerian drops help with pain.

Alternatively, there is the ozone autologous blood treatment, in which the autologous blood is enriched with ozone. At home, those affected can use shiatsu treatment and other methods of Chinese medicine.

However, the best course of action is to prevent hepatitis D outbreaks by seeing a doctor with hepatitis B already present.

Hepatitis D