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| == History== | | == History== |
| When hepatitis D infection occurs concurrently with [[hepatitis B]] infection, the incubation period of between 6 weeks and 6 months is the same for both. When viral hepatitis D infection occurs as a superinfection in someone already infected with hepatitis B, who remains [[HBsAg]] positive, the incubation period is thought to be between 2 and 10 weeks, on the basis of experimental infections in chimpanzees. Hepatitis D is most contagious just before the onset of symptoms but may remain infectious indefinitely in the HBsAg-positive person.<ref>Center for Substance Abuse Treatment. Screening for Infectious Diseases Among Substance Abusers. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1993. (Treatment Improvement Protocol (TIP) Series, No. 6.) Chapter 15 - Viral Hepatitis D.</ref> Symptoms of hepatitis D are similar to those of hepatitis B. The onset of symptoms is usually abrupt, and jaundice usually develops after the symptoms have disappeared.
| | Symptoms of hepatitis D are similar to those of hepatitis B. The onset of symptoms is usually abrupt, and jaundice usually develops after the symptoms have disappeared. |
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| With HBV and HDV co-infection, the fate of HDV is determined by the host response to HBV, which in more than 95% of adults results in viral clearance. Acute co-infection can be more severe than acute mono-infection with HBV, thereby resulting in acute liver failure; however, disease expression is wide-ranging. By contrast, HDV superinfection of an individual with chronic HBV results in chronic HDV infection in most people. In the remainder, replication of HDV stops, and the natural history of the disease is that of the underlying HBV; however, the residual liver disease might be advanced. Important evidence from an Italian cohort showed that 10% of patients with anti-HDV antibodies cleared HBsAg after a mean follow-up of 4 years, compared with 2·8% of those with HBV mono-infection.89 The mechanism for increased rate of HBsAg loss after clearance of HDV RNA is unknown, but an enhanced immune response against HBV and HDV seems plausible. Figure 3 shows the typical evolution of serological and virological markers in co-infected patients versus superinfected patients.
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| ==Symptoms== | | ==Symptoms== |
Revision as of 02:08, 11 August 2014