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HDV Accelerated Liver Disease — SCE Infectious Diseases MCQ

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ModerateHepatitisHDV Accelerated Liver DiseaseSCE Infectious Diseases

A 45-year-old man with known chronic hepatitis D co-infection asks about his prognosis compared to HBV monoinfection. What is the natural history of HDV co-infection compared to HBV alone?

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Correct answer: B — HDV co-infection significantly ACCELERATES liver disease progression — cirrhosis develops 3× faster than with HBV alone; HCC risk is increased; 5-year mortality is ~20% in cirrhotic HDV patients

Hepatitis D is the most severe form of viral hepatitis. HDV co-infection with HBV accelerates fibrosis progression ~3-fold compared to HBV monoinfection: cirrhosis develops in 15% of co-infected patients within 5 years (vs 3–5% in HBV alone). HDV also increases HCC risk independently of HBV. 5-year mortality in cirrhotic HDV patients is ~20%. This aggressive natural history underscores the importance of HDV screening in all HBsAg-positive patients and the urgency of effective HDV therapy (Bulevirtide, PEG-IFN).

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