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Hepatitis D — SCE Infectious Diseases MCQ

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HardHepatitisHepatitis DSCE Infectious Diseases

A 40-year-old man with no significant medical history develops acute viral hepatitis. His serology shows: HBsAg positive, IgM anti-HBc positive, anti-HDV IgM positive, HDV RNA positive. What is the clinical significance of hepatitis D co-infection?

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Correct answer: B — HBV/HDV co-infection is associated with more severe acute hepatitis and higher risk of fulminant liver failure

Simultaneous HBV/HDV co-infection (both acquired at the same time, as evidenced by IgM anti-HBc indicating acute HBV) causes more severe acute hepatitis with a higher rate of fulminant hepatic failure (~5% vs <1% for HBV alone). However, the rate of chronic HDV is lower in co-infection (~2%) compared to HDV superinfection of a chronic HBV carrier (>90% chronicity). HDV is a defective RNA virus requiring HBsAg for assembly. Treatment of chronic HDV includes Pegylated Interferon and the newer agent Bulevirtide.

Reference: EASL 2024 – Hepatitis D guidelines; WHO 2023 – Hepatitis D