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HDV Co-infection vs Superinfection — SCE Infectious Diseases MCQ

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HardHepatitisHDV Co-infection vs SuperinfectionSCE Infectious Diseases

A 35-year-old man presents with acute hepatitis. Serology shows: HBsAg positive, IgM anti-HBc positive, anti-HDV total positive, IgM anti-HDV positive, HDV RNA detected. HBV DNA is 2 × 10⁵ IU/mL. What type of HDV infection is this?

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Correct answer: A — HBV/HDV co-infection (simultaneous acute infection) — evidenced by IgM anti-HBc positivity indicating acute HBV

The key to distinguishing HDV co-infection from superinfection is the HBV status: IgM anti-HBc positive indicates acute HBV (co-infection — both viruses acquired simultaneously). In superinfection, the patient has pre-existing chronic HBV (IgM anti-HBc negative, IgG anti-HBc positive) and acquires HDV subsequently. The distinction matters clinically: co-infection usually resolves (>95% clear both viruses) whereas superinfection leads to chronic HDV in >90% of cases with accelerated liver disease progression.

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