Hepatitis D laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jolanta Marszalek, M.D. [2] João André Alves Silva, M.D. [3]

Overview

Laboratory Findings

Hepatitis D should be considered in any individual who is HBsAg positive or that has evidence of recent HBV infection. The diagnosis of acute hepatitis D is made after evaluation of serologic tests for the virus. Persons infected with HDV develop anti-HDV antibodies. Accordingly, every individual with an HBsAg positive test result, should be studied for the presence of anti-HDV IgG antibodies.[1]

The active form of the HDV infection was initially diagnosed by the detection of anti-HDV IgM antibodies. However, today the acute infection is confirmed with real-time PCR, by detecting serum HDV RNA.[2]


The table below describes the significance of diagnostic markers in HDV infection. [1]

Diagnostic Markers Significance
Anti-HDV IgG antibody
  • Positive in persons exposed to HDV
  • Persists, even after viral clearance
Anti-HDV IgM antibody
  • Positive in acute infection
  • Negative in past infection
  • Persists in many patients with chronic infection
HDV RNA

Qualitative

  • Marker of HDV replication
  • Positive in chronic infection
  • Negative in spontaneous or treatment-induced viral clearance

Quantitative

  • Useful in monitoring or predicting treatment response
HBsAg

Qualitative

  • Must be positive for HDV infectivity

Quantitative

  • Positively correlated with HDV RNA
  • Falling titer signals HBsAg loss, and hence HDV clearance
  • Useful in monitoring or predicting treatment response
HBeAg
  • Negative in an estimated 85% of patients
  • Associated with detectable anti-HBe
HBV DNA

Quantitative

  • Suppressed by HDV
  • Negative or low levels in most patients
  • May be increased in patients with detectable HBeAg
  • Can reactivate after spontaneous or treatment-induced clearance of HDV
ALT
  • Increased in most patients
  • Does not correlate well with degree of histological liver damage
Hepatitis D diagnosis Adapted from Treatment Options for Hepatitis Delta Virus Infection - Springer Science[3]

References

  1. 1.0 1.1 Hughes SA, Wedemeyer H, Harrison PM (2011). "Hepatitis delta virus". Lancet. 378 (9785): 73–85. doi:10.1016/S0140-6736(10)61931-9. PMID 21511329.
  2. Mederacke I, Bremer B, Heidrich B, Kirschner J, Deterding K, Bock T; et al. (2010). "Establishment of a novel quantitative hepatitis D virus (HDV) RNA assay using the Cobas TaqMan platform to study HDV RNA kinetics". J Clin Microbiol. 48 (6): 2022–9. doi:10.1128/JCM.00084-10. PMC 2884474. PMID 20351206.
  3. Heidrich B, Manns MP, Wedemeyer H (2013). "Treatment options for hepatitis delta virus infection". Curr Infect Dis Rep. 15 (1): 31–8. doi:10.1007/s11908-012-0307-z. PMID 23242761.

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