Algorithm(s)
PDF algorithm(s) available at www.arupconsult.com.
Hepatitis Delta Virus (HDV) Testing Algorithm
Hepatitis Virus Screening Algorithm
Clinical Background
Hepatitis delta-agent virus (HDV) is a subviral agent that is dependent on the hepatitis B (HBV) virus for its life cycle; therefore, HDV infection cannot occur in the absence of HBV infection.
Epidemiology
- Prevalence - 1.25 million people in the U.S. are HBV infected
- An estimated 70,000 people in the U.S. are HDV infected
- Transmission - parenteral
Organism
Risk Factors
- Transfusion with blood or blood products prior to 1990
- Current transfusion risk is 1/400,000 units transfused
- Positive result for another blood-borne pathogen (eg, HBV, HIV)
- History of intravenous drug or intranasal cocaine use
- Organ transplant recipient
- Hemodialysis
Clinical Presentation
- Two different disease courses - coinfection, superinfection
- HBV/HDV coinfection
- Disease process similar to HBV acute infection
- 70-80% of chronic HBV patients who are co-infected with HDV develop fulminant liver failure
- HDV superinfection superimposed on chronic HBV
- Worsening liver disease
- More common course associated with fulminant liver failure
Treatment
- Acute HDV infection - supportive care
- Chronic HDV infection - interferon-alfa, liver transplant
See Also
Algorithm(s)
PDF algorithm(s) available at www.arupconsult.com.
Hepatitis Delta Virus (HDV) Testing Algorithm
Hepatitis Virus Screening Algorithm
Diagnosis
Diagnosis
- Indications for testing - abrupt onset of nausea, anorexia or jaundice; patient with known chronic hepatitis B and worsening of liver disease
- Laboratory testing
- HDV antibody tests- positive in acute disease; should be followed by hepatitis B virus antigen testing and IgM antibody by EIA
- In acute co-infections, hepatitis D antigen (HDVAg) appears early, after hepatitis B virus surface antigen, and disappears with convalescence.
- Acute HDV infections are associated with anti-HDV IgM antibody
- Usually, only chronic cases demonstrate IgG antibody
- Both antibodies usually disappear following convalescence
- Simultaneous assessment of anti-hepatitis B virus core antibody IgM and HDVAg help differentiate coinfections (present) from super-infections (absent)
Differential Diagnosis
- Autoimmune hepatitis
- Toxin-induced hepatitis
- Non-alcoholic acute steatohepatitis (NASH)
- Epstein-Barr virus
- Cytomegalovirus
- Enterovirus
- Hepatitis E in patient from endemic area
- Tuberculosis
- Sarcoidosis
- Wilson disease
- Hemochromatosis
- Alpha-1-antitrypsin deficiency
Algorithm(s)
PDF algorithm(s) available at www.arupconsult.com.
Hepatitis Delta Virus (HDV) Testing Algorithm
Hepatitis Virus Screening Algorithm
Tests generally appear in the order most useful for common clinical situations
| Test name: Hepatitis Delta Virus Antibody
|
| ARUP #: 0020799 |
| Methodology: Enzyme Immunoassay
|
| Use: Diagnose hepatitis D infection in patient with documented acute or chronic hepatitis B and at risk for HDV infection |
| Limitations: |
| Follow-up: May want to order hepatitis B core antibody, IgM to determine whether HDV co-infection or super-infection |
| Test name: Hepatitis Delta Virus (HDV), IgM Antibody, EIA
|
| ARUP #: 0098507 |
| Methodology: Enzyme Immunoassay
|
| Use: Order to confirm acute HDV infection is acute rather than chronic |
| Limitations: |
| Follow-up: May want to order hepatitis B core antibody, IgM to determine whether HDV co-infection or super-infection |
| Test name: Hepatitis Delta Antigen
|
| ARUP #: 0098710 |
| Methodology: Enzyme Immunoassay
|
| Use: Diagnose hepatitis D infection in patient with documented acute or chronic hepatitis B and at risk for HDV infection |
| Limitations: |
| Follow-up: May want to order hepatitis B core antibody, IgM to determine whether HDV co-infection or super-infection |
Additional Tests Available
| Test name: Hepatitis B Virus Core Antibody, IgM
|
| ARUP #: 0020092 |
| Methodology: Chemiluminescent Immunoassay
|
| Comments: |
| Test name: Hepatitis B Virus Surface Antigen with Reflex to Confirmation
|
| ARUP #: 0020089 |
| Methodology: Chemiluminescent Immunoassay
|
| Comments: |
References
General References
Bean P. Latest discoveries on the infection and coinfection with hepatitis D virus. Am Clin Lab.
2002;
21(
5):
25-27.
Casey JL. Hepatitis delta virus: molecular biology, pathogenesis and immunology. Antivir Ther.
1998;
3(
Suppl 3):
37-42.
Farci P. Delta hepatitis: an update. J Hepatol.
2003;
39 Suppl 1:
S212-S219.
Fiedler M, Roggendorf M. Immunology of HDV infection. Curr Top Microbiol Immunol.
2006;
307:
187-209.
Husa P, Linhartova A, Nemecek V, Husova L. Hepatitis D. Acta Virol.
2005;
49(
4):
219-225.
Taylor JM. Hepatitis delta virus. Virology.
2006;
344(
1):
71-76.
Medical Reviewers
Slev, Patricia , Ph.D. Assistant Medical Director, Hepatitis and Retrovirus Serology and Special Chemistry at ARUP Laboratories
Comprehensive Review: September 2008
Last Update: September 2008
