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Hepatitis D . DR SACHIN VERMa MD( Medicine), ficm,fccs Consultant internal medicine & critical care Ivy hospital mohali. Introduction. Recognized in 1977 – co existent with HBV infection A defective RNA virus than need hepadnavirus (HBV) to replicate - PowerPoint PPT Presentation
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DR SACHIN VERMAMD( MEDICINE),FICM,FCCS
CONSULTANT INTERNAL MEDICINE & CRITICAL CARE
IVY HOSPITAL MOHALI
Hepatitis D
Introduction
Recognized in 1977 – co existent with HBV infection
A defective RNA virus than need hepadnavirus(HBV) to replicate
1980 – noticed the dependency of HDV to HBV (need HBsAg to as virion coat)
Associated with most severe form of acute and chronic HBsAg +
Epidemiology of Hepatitis D
Spread worldwide Highest in Russia, Romania, Southern Italy,
Mediterranean countries, Africa, South America Low in China, Taiwan, India Latest trends
New foci in Okinawa, certain area of China, India, Albania
Decreasing trend in Mediterranean
Prevalence in region
New Delhi : 8.1% in 1996[Irshad M et al. Eur J Gastroenterol Hepatol 1996; 8: 995-99816]
New Delhi: 10.6% in 2005[Chakraborty P et al. Indian J
Med Res2005; 122: 254-25715]
Chandigarh :14.2%[Singh et al. J Viral Hepat 1995; 2: 151-15417].
Ludhiana:10% in HBsAg-positive patients[Ghuman et al. Indian J Med Sci 1995; 49: 227-23023].
Mode of Transmission
Spread Percutaneous and sexually and through body
fluid/blood Potentially infectious in whole phase
People at risk HBV carrier, HBV unvaccinated person
IVDU Unprotected sex Exposed to unscreen blood, body fluid People receiving blood, blood product
Hepatitis D Features
IP – 5 to 64 days
Super-infection* or co-infection with HBV
CLINICAL FEATURES :
In acute CO-Infection jaundice ,fatigue, abdominal pain, loss of
appetite , nausea, vomiting ,joint pain, dark (tea colored) urine
In super-infection
CLD and HCC.
DIAGNOSIS Following HBV-HDV co-infection both IgM
anti-HDV during the acute illness and IgG anti-HDV during convalescence are detectable
Following HBV-HDV super infection, chronic HDV infection with detectable HDAg usually occurs. Both IgM anti-HDV and IgG anti-HDV remain detectable.
DIAGNOSIS
Anti LKM3 antibodies
Serologic Course
Serologic Course
Prevention HBV-HDV Coinfection
Pre or postexposure prophylaxis to prevent HBV infection.
HBV-HDV SuperinfectionEducation to reduce risk behaviors among
persons with chronic HBV infection
TREATMENT:1. Acute HDV infection
a) Supportive care
2. Chronic HDV infection 1. interferon-alfa 2. liver transplant
a-interferon 2b 9 mu sc tiw, Rx > 12 months
21-50% lose HDV RNA and have improved histology
Relapse occurs in almost all patients stopping treatment
Can stop treatment if HBV Surface Ag disappears (rare)
Thank you