saudigastro.com/patients/hepatitis-d
Category
Serious
Red flags
4
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
Hepatitis D is caused by the hepatitis D virus (HDV, also called delta virus). This virus is incomplete: it can only cause infection in a person who also has hepatitis B, because it needs the hepatitis B virus coat to multiply. Having both together usually causes more liver damage than hepatitis B alone, and cirrhosis (advanced scarring of the liver) can develop faster in some people.
How common is it?
Hepatitis D is much less common than hepatitis B, and is more frequent in certain regions of the world. It is often under-diagnosed because many people with hepatitis B are never tested for it.
Why does it happen?
It spreads like hepatitis B: through contact with infected blood or body fluids, such as shared needles or razors, unsafe medical or dental procedures, unprotected sex, or from mother to baby. It can be caught at the same time as hepatitis B (co-infection) or by someone who already carries hepatitis B (superinfection). It is not spread by casual contact, food or water.
Symptoms
- Many people have no symptoms for years
- Tiredness and weakness
- Nausea and loss of appetite
- Pain in the upper right abdomen
- Jaundice (yellow skin and eyes) and dark urine
- Later: swelling of the legs or abdomen and easy bruising if cirrhosis develops
Red flags — seek urgent medical care
Vomiting blood or black, tarry stools
Possible bleeding from swollen veins in cirrhosis. Go to the emergency department now.
Confusion, extreme sleepiness or personality change
May be liver failure or hepatic encephalopathy. Emergency care is needed.
Rapidly worsening jaundice, or a swollen belly with fever or pain
May indicate a serious flare or infection of the abdominal fluid. Seek urgent care.
Known hepatitis B with new tiredness or abnormal liver tests
Ask your doctor to test for hepatitis D.
How is it diagnosed?
Anyone with hepatitis B should be considered for a hepatitis D antibody test. If positive, a blood test for HDV RNA shows whether the virus is active. Doctors also assess liver scarring using blood tests, FibroScan (an ultrasound-based stiffness test) and sometimes imaging or biopsy, and check for complications of cirrhosis.
Outlook — what to expect
The course varies. Without treatment, hepatitis D can lead to cirrhosis and liver cancer more often than hepatitis B alone, so regular follow-up matters. Newer treatments have improved the options, and early care with a liver specialist gives the best outcomes.
Treatment
Habits & Lifestyle
Protecting your liver and others is central.
- Avoid alcohol completely
- Do not share razors, toothbrushes, needles or nail tools
- Use condoms unless your partner is vaccinated against hepatitis B
- Cover cuts and clean blood spills with household bleach and gloves
- Keep all follow-up appointments and regular liver checks
Diet
A healthy, balanced diet supports the liver.
- Eat a balanced diet with enough protein, fruit and vegetables
- Limit salt if you have fluid build-up
- Avoid raw shellfish if you have advanced liver disease
- Avoid herbal and supplement products unless your doctor approves
Medications
Treatment is decided by a liver specialist, depending on virus activity and liver scarring.
- Medicines that target hepatitis D, including newer options, may be offered where available
- Interferon-type injections have been used in some patients
- Treatment of the underlying hepatitis B with antiviral tablets is often continued
- Do not stop any hepatitis B medicine without your doctor's advice
Procedures & Surgery
Procedures are used to monitor or treat complications.
- Regular ultrasound (with or without blood tests) to look for liver cancer if you have cirrhosis or other risk
- Endoscopy to check for swollen veins in cirrhosis
- Liver transplant assessment for advanced disease or liver failure
Living with the condition
- Family members and sexual partners should be tested and vaccinated against hepatitis B
- You can usually live and work normally; follow your hospital's advice on safe practices
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- Is my hepatitis D virus active, and how much liver scarring do I have?
- Do I need treatment now?
- How often do I need ultrasound and blood tests?
- Should my family be tested and vaccinated?
- Which medicines should I avoid?
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Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide