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Hepatitis D — RACP Adult Medicine MCQ

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ModerateGastroenterologyHepatitis DRACP Adult Medicine

A 45-year-old man presents with fatigue, elevated ALT (120 U/L) for 6 months. Hepatitis B: HBsAg positive, HBeAg negative, anti-HBe positive, HBV DNA 45000 IU/mL, anti-HDV positive, HDV RNA positive. He is from the Mediterranean region. What is the additional hepatitis diagnosis?

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Correct answer: A — Hepatitis D (delta) co-infection

HBsAg positive + positive anti-HDV + positive HDV RNA = hepatitis D (delta) virus co-infection/superinfection. HDV is a defective RNA virus requiring HBsAg for its replication. HDV superinfection in chronic HBV carriers causes accelerated liver disease progression and higher risk of cirrhosis/HCC than HBV alone. Treatment: pegylated interferon-alpha for 48 weeks (the only currently approved therapy). Bulevirtide (entry inhibitor) is a newer option.

Reference: GESA – 2024 – HDV; EASL 2024; WHO 2024