Hepatitis D Workup

Author: Praveen K Roy, MD, AGAF; Chief Editor: Julian Katz, MD more...

Updated: Dec 2, 2011

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Approach Considerations

Laboratory studies

The following serum test results are present in patients with coinfection with hepatitis D virus (HDV) and HBV:

Results are positive for HDV antigen in 20%
Results are positive for HDV ribonucleic acid (RNA) in 90%; reverse transcriptase polymerase chain reaction assay is currently the most sensitive assay for the detection of HDV viremia
Results for anti-HDV immunoglobulin M (IgM) are positive initially and then are positive for anti-HDV immunoglobulin G; the finding of antigen A antibody to HDV is almost exclusively associated with chronic HDV infections
Results for anti-HB core IgM are positive, except with superinfection, in which anti-HB core IgM is absent
A hepatic panel may show alanine aminotransferase and aspartate aminotransferase levels greater than 500 IU/L
For synthetic liver function markers, an international normalized ratio greater than 1.5 or a prothrombin time greater than 17 seconds may be the first evidence of fulminant liver failure

HBsAg is required for HDV replication but may be suppressed to undetectable levels with active HDV replication.

Imaging studies

Right upper quadrant ultrasonography helps in the evaluation for biliary obstruction and hepatocellular carcinoma.

Perform cholescintigraphy (hydroxy iminodiacetic acid) to exclude acute cholecystitis, if clinically indicated.

Perform computed tomography (CT) scanning or magnetic resonance imaging (MRI) if hepatocellular carcinoma is suggested. (An alpha-fetoprotein level greater than 250 ng/mL is highly suggestive of hepatocellular carcinoma.)

Procedures and histologic findings

Results from liver biopsy in patients with acute disease are consistent with acute hepatitis, and, generally, a biopsy is not indicated. Consider liver biopsy if the serologic diagnosis of hepatitis is inconclusive.

In patients with chronic liver disease, liver biopsy is indicated to evaluate for the presence of fibrosis and cirrhosis.

Hepatitis D virus (HDV) antigen immunohistochemical analysis of liver tissue is the criterion standard for establishing a diagnosis of persistent HDV infection.

Histologic features are very similar to those observed in patients with HBV infection. Acidophilic bodies and degeneration of hepatocytes with acidophilic cytoplasm are present. The few inflammatory cells (lymphocytes) likely represent the direct cytotoxicity of HDV. Results of immunohistochemical staining for HDV antigen are positive. With superinfection, staining often reveals that HBsAg is suppressed.

Proceed to Treatment & Management

Contributor Information and Disclosures

Author

Praveen K Roy, MD, AGAF Gastroenterologist, Ochsner Clinic Foundation; Adjunct Associate Research Scientist, Lovelace Respiratory Research Institute; Editor-in-Chief, The Internet Journal of Gasteroenterology; Editorial Board, Signal Transduction Insights; Editorial Board, The Internet Journal of Epidemiology; Editorial Board, Gastrointestinal Endoscopy Review Letter

Praveen K Roy, MD, AGAF is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, and American Society of Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Coauthor(s)

Sean R Lacey, MD Associate Professor of Gastroenterology, Pennsylvania State University College of Medicine

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

Chief Editor

Julian Katz, MD Clinical Professor of Medicine, Drexel University College of Medicine

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 & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

David Eric Bernstein, MD Director of Hepatology, North Shore University Hospital; Professor of Clinical Medicine, Albert Einstein College 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.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

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