eMedicine Specialties > Gastroenterology > Liver

Hepatitis D: Follow-up

Author: Sean R Lacey, MD, Consulting Staff, Department of Medicine, Division of Gastroenterology, Gastroenterology Associates, Ltd, Lehigh Valley Hospital
Contributor Information and Disclosures

Updated: Oct 31, 2006

Follow-up

Further Inpatient Care

  • Observe synthetic liver function and mental status for signs of deterioration.
  • Consider liver biopsy if the serologic diagnosis of hepatitis is inconclusive.

Further Outpatient Care

  • Follow-up is recommended for at least 6 months to determine if chronic HBV and HDV infection develop.
  • Perform a liver biopsy to stage liver disease prior to beginning interferon alfa therapy.

Transfer

  • Patients with evidence of decompensated liver disease or fulminant liver failure should be immediately transferred to a center capable of performing a liver transplantation.

Deterrence/Prevention

  • No vaccine is available for HDV, but the HBV vaccination is effective against HDV.

Complications

  • Liver failure
  • Hepatocellular carcinoma
  • Autoimmune manifestations, often including antinuclear antibodies and smooth muscle antibodies

Prognosis

  • Prognosis is excellent for those with co-infection in whom treatment eradicates both viruses.
  • Prognosis is variable for those who are superinfected. It depends on the duration and severity of HBV infection, alcohol consumption, comorbid illnesses, and age.
  • In patients who undergo liver transplantation for chronic liver disease secondary to HBV and HDV infection, HDV seems to suppress the replication of HBV in the transplanted liver and may help prolong graft survival. However, fulminant hepatitis from recurrent HBV and HDV infection in the transplanted liver has resulted in patient death or the need to retransplant.

Patient Education

  • Modify high-risk behaviors, including intravenous drug use or unsafe sexual practices.
  • Promote the use of universal precautions for health care workers.
  • Patients with chronic HDV and HBV infection should not donate blood, share toothbrushes or razors, or consume alcohol. Precautions should be observed.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize HDV in the setting of acute HBV co-infection
  • Failure to closely monitor synthetic liver function
  • Failure to transfer patient to a medical center capable of performing a liver transplantation early in the course of disease
  • Failure to inform patients with alcoholism to abstain from alcohol consumption and to seek professional counseling in order to be considered a transplantation candidate, a prerequisite in some centers

Special Concerns

  • Additional information regarding chronic viral hepatitis is available from the American Liver Foundation, 75 Maiden Lane, Suite 603, New York, NY 10038 USA; (800) 465-4837, toll-free.
 


More on Hepatitis D

Overview: Hepatitis D
Differential Diagnoses & Workup: Hepatitis D
Treatment & Medication: Hepatitis D
Follow-up: Hepatitis D
References
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References

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Further Reading

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Keywords

HDV, HDV infection, viral hepatitis, delta hepatitis, delta virus, hepatitis delta, hepatitis B virus, HBV, hepatitis B surface antigen, HBsAg, liver failure, liver infection, acute fulminant liver failure, chronic liver infection, end-stage liver disease, end-stage liver disease, ESLD, cirrhosis, hepatocellular carcinoma, HCC, liver transplantation, hepatic transplantation

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Contributor Information and Disclosures

Author

Sean R Lacey, MD, Consulting Staff, Department of Medicine, Division of Gastroenterology, Gastroenterology Associates, Ltd, Lehigh Valley Hospital
Sean R Lacey, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, and American Gastroenterological Association
Disclosure: astra zenaca Honoraria Speaking and teaching

Medical Editor

David Eric Bernstein, MD, Chief, Section of Hepatology, North Shore University Hospital, Director, Associate Professor, Department of Internal Medicine, Division of Hepatology, New York University School of Medicine
David Eric Bernstein, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Oscar S Brann, MD, FACP, Associate Clinical Professor, Department of Medicine, University of California at San Diego; Consulting Staff, Mecklenburg Medical Group
Oscar S Brann, MD, FACP is a member of the following medical societies: American Gastroenterological Association
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Assistant Dean for Medical Curriculum, Associate Professor of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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