Let's learn more about Hepatitis D. This is a bit special!

You've probably heard of various liver diseases. Today we're going to talk about a similar, but slightly different, liver disease. That's Hepatitis D. What's so special about it, how to avoid it, let's find out all about it today.

What is Hepatitis D?

Simply put, Hepatitis D is a viral disease that causes inflammation of the liver . However, the biggest difference is that the Hepatitis D virus (HDV) cannot cause the disease on its own. Isn't it amazing? Yes, in order for this virus to cause disease in your body, it must be combined with the Hepatitis B virus (HBV) . That means, you can only develop Hepatitis D when you already have Hepatitis B, or when you develop Hepatitis B. Do you understand? Not at all.

Hepatitis D infection can occur in two main ways:

1. Acute infection: In this case, symptoms appear more quickly and may last for a few weeks or months. Sometimes, it can get better on its own.

2. Chronic infection: This is the more dangerous one. An acute infection can become chronic. In that case, symptoms last for more than six months. This can cause long-term damage to the liver.

What are the types of Hepatitis D?

Let's now look at the two main types of Hepatitis D infection in a little more detail.

What is Coinfection?

Coinfection is when you are infected with both hepatitis B virus (HBV) and hepatitis D virus (HDV) at the same time . Think of it like being attacked by both viruses at once. In this case, the symptoms are usually similar to those of hepatitis B, but the two viruses can be more severe because they are present together. This means that the illness can be a little more severe. But there is good news. When you have this combination, the chances of it becoming chronic are sometimes lower.

What is superinfection?

Now, superinfection is a slightly different and more dangerous condition . What happens is that you already have a hepatitis B infection , meaning you have the HBV virus in your body (possibly chronically). Then, you get a new infection with the hepatitis D virus (HDV). It's like having one disease and then another disease comes along. When you have a superinfection like this, your previous hepatitis B symptoms may suddenly reappear or become more severe . In most cases, this superinfection has a very high chance of becoming a chronic disease (about 90%).That means the disease can persist in the body for a long time and the rate of liver damage is also high.

What are the symptoms of Hepatitis D?

The symptoms of Hepatitis D are very similar to those of other types of hepatitis. Some people may not have any symptoms at all. However, if symptoms do occur, you can expect the following:

• Fever .
• Stomach pain , especially in the upper right side of the abdomen (where the liver is).
• Nausea and vomiting .
• Anorexia , the loss of any desire to eat.
• Your urine is turning dark , like the color of tea water.
• On the other hand, your stool will turn pale, maybe even gray .
• The eyes turn yellow, the skin turns yellow – this is what we call jaundice . This happens when the liver cannot properly process a substance called bilirubin.
• Feeling tired .

Hepatitis D infection can worsen the symptoms of hepatitis B that you already have.

What causes Hepatitis D?

The reason for this is the Hepatitis Delta Virus , or HDV for short. But as we said before, it can't do anything on its own. It definitely needs the Hepatitis B Virus (HBV) to survive and make more copies of the virus (i.e., to spread). That's why, if you want to get Hepatitis D, you also need to have the HBV virus in your body.

How is Hepatitis D transmitted?

Hepatitis D is transmitted in the same way as Hepatitis B. That is, when the blood or other body fluids (e.g., semen, vaginal secretions) of an infected person enter the body of a healthy person. Here are the main ways it is transmitted:

• From unprotected sexual intercourse (that is, not using a condom during vaginal, oral, or anal sex).
• By sharing needles and syringes used when injecting drugs . This can also happen if the equipment used to inject certain drugs is not properly cleaned.
• For healthcare workers, accidentally getting stuck with something like a needle while working with patients.
• It is possible for the virus to be transmitted from mother to baby during childbirth. However, this is rare , especially if the necessary precautions are taken.
• There is also a risk in using unsterilized equipment when getting tattoos or ear piercings.

Who is at higher risk of developing Hepatitis D?

The following groups are at higher risk of developing Hepatitis D:

• People who already have Hepatitis B infection. (Without this, D wouldn't be formed!)
• People who inject drugs , especially if they share needles.
• People who have sex with someone who has both hepatitis B (HBV) and D (HDV).
• People who live in the same household as someone with hepatitis B (HBV) and D (HDV) (e.g., if they share items such as razors and toothbrushes).
• People with HIV infection .
• When men have sex with men (unprotected).
• People who work in healthcare or other fields that frequently come into contact with blood and body fluids.
• People with kidney disease who are undergoing hemodialysis .

What are the possible complications of Hepatitis D?

Hepatitis D, especially if it becomes chronic, can cause serious liver damage. Here are some of the main complications:

• Cirrhosis: This is when the liver gradually becomes scarred and unable to perform its normal functions. Just as a scar forms on our skin when we get a wound, scarring also occurs in the liver. This impairs the functioning of the liver.
• Liver failure: This is a serious condition. The liver is unable to do any of its work. It can be life-threatening.
• Hepatocellular carcinoma: This is a type of cancer that develops in the liver. People with chronic hepatitis D are at higher risk of developing this cancer.

How do you find out if you have Hepatitis D?

If you have symptoms of Hepatitis D, or if you are in a risk group, it is best to see a doctor and get tested. Doctors mainly use blood tests to diagnose this. The lab will check your blood for parts of the virus (HDV RNA) or for antibodies (anti-HDV antibodies) that have been produced against the virus.

In addition, you may need to have an ultrasound scan, specialized scans such as FibroScan or Elastography , and sometimes even a liver biopsy to check the condition of your liver and see if there are any scars.

Is there a complete cure for Hepatitis D?

To be honest, there is no cure for Hepatitis D yet . This is the saddest thing. However, acute HDV infections can sometimes resolve without any treatment (especially in cases of coinfection).

But for people with chronic hepatitis D, doctors can offer these treatments. These treatments try to control the virus, reduce damage to the liver, and prevent complications.

• Peginterferon alfa injection: This is a shot you take once a week. It's usually given for about a year. It helps your immune system fight infections. But it can have side effects.
• Bulevirtide (Hepcludex®): This is a new antiviral drug. It prevents the HDV virus from entering liver cells. It has been approved for the treatment of HDV in some countries, but not everywhere.
• Liver transplant: If your liver is severely damaged and failing, a new liver transplant may be necessary as a last resort.

New treatments are still being researched.

What happens if I have Hepatitis D?

If you are diagnosed with hepatitis D, your doctor will monitor your liver health closely . This may include regular check-ups, blood tests, and scans. Acute hepatitis D or HBV/HDV coinfection may resolve without treatment in a few weeks or months.

However, in most cases, a superinfection becomes chronic hepatitis D. Chronic disease can last longer than six months, sometimes even years. Your doctor may treat you for a year or more.

What is the prognosis of Hepatitis D?

Death from acute HBV/HDV coinfection is very rare (about 1-5%), but recovery can take weeks or months.

However, chronic HBV/HDV superinfection is more serious . Between 70% and 80% of people with this condition will eventually develop cirrhosis. This can happen quickly, within the first two years of infection, or it can take 5 to 10 years. Unfortunately, a significant proportion of people with chronic hepatitis D (some reports say as many as 15% within 5-10 years) will die from complications such as liver cancer or liver failure. That is why early diagnosis and management are important.

Can Hepatitis D be prevented?

Yes, you can! The best and most important way to protect yourself from Hepatitis D is to protect yourself from Hepatitis B. Because, Hepatitis D cannot develop without Hepatitis B.

• Get vaccinated against Hepatitis B.This is the most important thing. This vaccine is very safe and effective. If you have not had Hepatitis B, definitely get this vaccine.
• If you think you may have been exposed to hepatitis B (for example, if you were exposed to the blood of an infected person), you can get vaccinated as soon as possible. You can also get a treatment called hepatitis B immune globulin (HBIG) within 24-48 hours. This can help prevent infection.

If you already have Hepatitis B, you can do these things to reduce your risk of developing a superinfection:

• Wear sterile gloves when you are likely to come into contact with blood, wound pus, or other body fluids.
• Do not share needles and syringes used to inject drugs with others .
• Do not share personal items such as toothbrushes and razors with others .
• Use a condom during any type of sexual intercourse.
• Take antiviral medication for Hepatitis B as prescribed by your doctor.

If you are pregnant and have Hepatitis B or HBV/HDV infection, doctors can greatly reduce the risk of your baby becoming infected by vaccinating and treating your baby immediately after birth.

How can I take care of my health? (If I have hepatitis)

If you have hepatitis (B or D), there are several things you can do to reduce the damage to your liver:

• Avoid alcohol completely. When alcohol enters the liver, it damages its cells. An already sick liver cannot handle this.
• If you smoke, stop, or don't start. Smoking is also bad for the liver.
• Maintain a healthy weight that suits you. Being overweight/obesity can worsen fatty liver disease by causing fat to build up in the liver.
• Ask your doctor or nutritionist about the foods you should eat and avoid to keep your liver healthy. A balanced diet is important.
• Ask your doctor which over-the-counter (OTC) medications are safe for you and which you should limit. For example, taking painkillers like acetaminophen (Tylenol®) regularly is not good for your liver. So use them only as directed by your doctor.
• Go to your doctor's appointments on time and get all the tests recommended to check your liver health. This is very important.

When should I see a doctor?

If you have symptoms of hepatitis (such as fever, body aches, loss of appetite, jaundice), or if you have hepatitis B and your symptoms suddenly worsen, be sure to see a doctor . Also, if you think you may have been exposed to hepatitis B or D, seek medical advice.

When should I go to the Emergency Treatment Unit (ETU) ?

If you have these severe symptoms, go to a hospital emergency room immediately :

• If you have a severe stomach ache .
• If you are vomiting heavily , or if you cannot keep anything down.
• If you vomit blood or vomit that looks like coffee grounds.
• If jaundice has increased (eyes and skin turn a dark yellow color).
• If consciousness seems to be impaired , if it seems difficult to stay conscious, if confusion occurs (we call this hepatic encephalopathy ).
• If the urine is dark brown or the amount of urine produced is greatly reduced.
• If your stool is clay-colored or light-colored .
• If your stomach feels very swollen.

These may be signs of severe liver damage.

What questions should I ask my doctor?

When you see a doctor, it can be helpful to ask questions like these:

• What type of hepatitis do I have exactly?
• What treatment options do I have?
• How long does this treatment take?
• How should I use this medicine? Are there any side effects?
• Are there any new symptoms or worsening symptoms that I should be especially aware of?
• How is my liver doing now? What tests should I have done in the future?
• What should I do to prevent this from spreading to others?
• If I have Hepatitis B, what else can I do to prevent getting Hepatitis D?

What is the difference between Hepatitis B and Hepatitis D?

Hepatitis B and Hepatitis D are two types of viral infections. Both affect the liver. But the main difference is that Hepatitis D can only infect you if you have Hepatitis B, or if you already have Hepatitis B. Hepatitis D virus (HDV) is like an "incomplete" virus; it can't work on its own, it needs "help" from HBV.

Not everyone who has hepatitis B will develop hepatitis D. In fact, many people who have hepatitis B do not have hepatitis D.

How common is Hepatitis D?

Between 5% and 15% of people worldwide have hepatitis B.– That means between 12 and 45 million people – are also infected with HDV, experts say. Hepatitis D is most common in parts of Africa (e.g., Central Africa), Asia (e.g., Mongolia, Pakistan), the Amazon River Basin in South America, and parts of Eastern Europe. It is not as common in the United States or Western Europe. It is not as common in Sri Lanka, but the risk is there.

The hepatitis D virus works a little differently than other viruses. That is, it requires the help of the hepatitis B virus (HBV) to cause an infection. Fortunately, any steps you can take to protect yourself from HBV will also help protect you from hepatitis D. Also, the recent introduction of the hepatitis B vaccine has led to a decrease in the number of people with hepatitis B and, consequently, hepatitis D worldwide. This is especially important because some people can have hepatitis B without having any symptoms.

If you have a chronic infection, work with your doctor to monitor your liver health regularly. Research into new medications may provide more treatment options in the future.

The most important thing we need to learn from this is

So, Hepatitis D is a special type of liver disease. The most important thing to remember is that for this to occur, the Hepatitis B virus must also be present in the body. Therefore, protecting yourself from Hepatitis B is the best way to protect yourself from Hepatitis D.

Getting the Hepatitis B vaccine, practicing safe sex, and not sharing needles if you use drugs will all protect you from Hepatitis D.

If you have Hepatitis B, don't panic. But be sure to follow your doctor's instructions, get regular tests, and avoid things that can damage your liver (especially alcohol and certain over-the-counter medications). This can help reduce your risk of developing Hepatitis D.

Be aware of the symptoms. If you have any doubts, don't delay seeing a doctor. The sooner you find out, the better your chances of living a healthy life with fewer complications.

` Hepatitis D, Hepatitis D, Liver, Liver disease, Virus, Hepatitis B, Hepatitis B, HDV, HBV, Jaundice, Cirrhosis, Liver failure, Liver cancer