Thursday, May 23, 2024

Why Does Hepatitis D Need Hepatitis B

Should I Be Screened For Hepatitis B

The Truth about Hepatitis B

Screening is testing for a disease in people who have no symptoms. Doctors use blood tests to screen for hepatitis B. Many people who have hepatitis B dont have symptoms and dont know they are infected with hepatitis B. Screening tests can help doctors diagnose and treat hepatitis B, which can lower your chances of developing serious health problems.

Your doctor may recommend screening for hepatitis B if you9,14

  • are pregnant
  • were born in an area of the world where 2 percent or more of the population has hepatitis B infection, which includes Africa, Asia, and parts of the Middle East, Eastern Europe, and South America
  • didnt receive the hepatitis B vaccine as an infant and have parents who were born in an area where 8 percent or more of the population had hepatitis B infection, which includes sub-Saharan Africa and parts of Asia
  • are HIV-positive
  • are a man who has sex with men
  • have lived with or had sex with a person who has hepatitis B
  • have an increased chance of infection due to other factors

New Therapeutic Approaches Targeting Hbsag

Apart from the above-mentioned therapies, any new therapeutic that leads to functional cure in HBV monoinfected patients could be helpful in HBV/HDV coinfected ones. RNA interference and antisense oligonucleotides showed substantial declines of HBsAg in few weeks of administration in the absence of peg-IFN, suggesting a potential role also in the treatment of coinfected patients.

Interfering With Viral Replication

Viral targets

In contrast to other RNA viruses that encode RNA-dependent RNA-polymerases for replication and mRNA synthesis, HDV recruits and reprogrammes the cellular Pol II to achieve these goals. Accordingly, an important viral drug target is lacking. Nevertheless, crucial steps in the viral life cycle like the ribozyme-mediated self-cleavage of genomic and antigenomic RNA oligomers or the HDAg-dependent regulation of RNA replication and mRNA synthesis are attractive viral structures suitable for drug targeting. Inactivation of the S-HDAg could induce a selective shut down of RNA synthesis . Alternatively, abolition of the interaction of the prenylated C-terminus of L-HDAg with the cytosolic loop in the HBV S-domain by small molecules would inhibit virus release similar to LNF, which targets the corresponding host enzyme . No such drugs have been identified so far, however applying the new replication systems mentioned above will facilitate screening approaches and drug candidate identification in the future.

Cellular targets

Beside these well-characterised host factors additional approaches using siRNA or drug libraries in susceptible cell lines will allow to identify novel host factors in the future and it will be a challenging task to identify those that allow intervention and are tolerable regarding side effects.

Also Check: Where To Get Tested For Hiv And Hepatitis

Open Questions And Future Directions

  • Can hepatitis D virus establish transcriptionally silenced but reactivatable episomes in hepatocytes as an additional mechanism of persistence?

  • To what extent do the eight HDV genotypes differ in replication efficacy and sensitivity against the upcoming novel treatments?

  • Do HDV-targeted therapies lead to a restoration of HDV-specific immunity?

  • Are these restored immune responses required for treatment response? Are they required for prevention of viral relapse? Of note, there may be differences in treatment regimens that are associated with alanine aminotransferase flares combination therapy) compared with treatment regimens without ALT flares .

  • How can a synergistic potential of antiviral drugs and immune-modulators be translated into curative regimens?

  • Are there baseline or on-treatment predictors to sustained HDV virological response for the different treatment strategies?

  • Is a sustained HDV virological response without hepatitis B surface antigen loss a realistic and achievable aim for treatment regimens without IFNs?

  • Are drugs aiming at HBsAg loss effective and safe in patients with chronic hepatitis B virus/HDV coinfection?

  • Last but not least, since HDV is prevalent in low-income countries and migrant populations, it will be important to establish new concepts to foster diagnosis and access to care.

Which Adults Should Be Vaccinated Against Hepatitis B

Hepatitis B Transmission for Those Newly Diagnosed

According to CDC recommendations, adults in the following groups are recommended to receive hepatitis B vaccine:


  • All people age 18 years and younger.
  • Anyone 19 years and older who wants to be protected from hepatitis B.

People at risk for infection by sexual exposure

  • Sex partners of people who are hepatitis B surface antigen -positive.
  • Sexually active people who are not in long-term, mutually monogamous relationships.
  • People seeking evaluation or treatment for a sexually transmitted disease.
  • Men who have sex with men.

People at risk for infection by percutaneous or permucosal exposure to blood or body fluids

  • Current or recent illegal injection drug users.
  • Household contacts of people who are HBsAg-positive.
  • Residents and staff of facilities for developmentally challenged people.
  • Healthcare and public safety workers with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids.
  • People with end-stage renal disease, including predialysis, hemo-, peritoneal- and home-dialysis patients.


  • International travelers to regions with intermediate or high levels of endemic HBV infection.
  • People with chronic liver disease.
  • People with HIV infection.
  • People with diabetes who are age 19 through 59 years. For those age 60 and older, clinicians should make a determination of need for
  • vaccination based on their patients’ situation.

In a future issue, we will review the various hepatitis B serologic tests, who needs testing, and when they need it .

Recommended Reading: Hepatitis B Surface Antibody Ql Reactive Means

Report To Minnesota Department Of Health

  • Report the following to the Minnesota Department of Health:
  • Hepatitis D infection
  • Report to the Minnesota Department of Health by any of the following methods:
  • Phone: 651-201-5414 or 1-877-676-5414
  • Fax: 1-800-334-4931
  • Mail: Minnesota Department of Health Disease Report Card, P.O. Box 64975, St. Paul, MN 55164-0975
  • How Do You Get It

    HAV can be present in the stool and blood of someone with the virus. Its mainly transmitted through the fecal-oral route, which involves ingesting virus thats present in the stool of someone with hepatitis A.

    There are several ways you can get hepatitis A:

    • having close person-to-person contact with someone who has hepatitis A, such as:
    • taking care of someone whos currently sick
    • having sex with someone who has the virus
  • consuming contaminated food or drink, including:
  • eating food thats been prepared by someone with hepatitis A who didnt wash their hands after using the bathroom
  • drinking untreated, infected water
  • eating food thats been washed or prepared using untreated water
  • eating undercooked shellfish that was sourced from sewage-contaminated water
  • having contact with contaminated objects, such as toilets and diaper changing areas and then not washing your hands
  • Recommended Reading: How Do You Find Out If You Have Hepatitis

    Who Is More Likely To Get Hepatitis B

    People are more likely to get hepatitis B if they are born to a mother who has hepatitis B. The virus can spread from mother to child during birth. For this reason, people are more likely to have hepatitis B if they

    • were born in a part of the world where 2 percent or more of the population has hepatitis B infection
    • were born in the United States, didnt receive the hepatitis B vaccine as an infant, and have parents who were born in an area where 8 percent or more of the population had hepatitis B infection

    People are also more likely to have hepatitis B if they

    • are infected with HIV, because hepatitis B and HIV spread in similar ways
    • have lived with or had sex with someone who has hepatitis B
    • have had more than one sex partner in the last 6 months or have a history of sexually transmitted disease
    • are men who have sex with men
    • are injection drug users
    • work in a profession, such as health care, in which they have contact with blood, needles, or body fluids at work
    • live or work in a care facility for people with developmental disabilities
    • have been on kidney dialysis
    • live or work in a prison
    • had a blood transfusion or organ transplant before the mid-1980s

    In the United States, hepatitis B spreads among adults mainly through contact with infected blood through the skin, such as during injection drug use, and through sexual contact.12

    How Are Hepatitis B And C Treated

    What you need to know about Hepatitis B

    Hepatitis B: Not all patients with chronic hepatitis B infection require treatment. At Yale Medicine, specialists decide on an individual basis whether a patient is an appropriate candidate for treatment. Generally, patients require treatment when their hepatitis B virus level is high, and when laboratory tests demonstrate significant inflammation or injury to the liver.

    There are currently seven approved drugs for hepatitis B, two of which are considered to be first-line treatments. These drugs are oral pills taken once daily, and while they’re very effective at suppressing the virus to very low or undetectable levels over the long term, they are not considered curative.

    Therefore, the goal of treatment is to control the virus long-term and decrease the risk of hepatitis B related complications such as cirrhosis and liver cancer.

    Hepatitis C: For the greater part of the last 20 years, treatment of hepatitis C required the use of a chemotherapy-like injection drug called interferon, which has been associated with serious side effects and a low cure rate. Fortunately, advances in hepatitis C treatments within the last three years now allow for the use of oral medications that are significant improvements in terms of safety and effectiveness.

    Read Also: Could I Have Hepatitis And Not Know It

    Prevention Of Hepatitis D

    • Exclusion of people with hepatitis D from childcare, preschool, school and work is not necessary.
    • Hepatitis B vaccination will prevent infection with hepatitis D. Hepatitis B vaccination is recommended for infants and those at a higher risk of acquiring hepatitis B infection and/or at higher risk of severe infection. Vaccination for hepatitis B, when given to newborn infants, is effective in preventing hepatitis D .
    • Any open sores, cuts or abrasions should be covered with waterproof dressings
    • Practice safer sex use condoms consistently and correctly.
    • Injecting drug users should never share injecting equipment.
    • If required to handle blood or body fluids, the use of standard precautions will reduce the risk of spreading hepatitis D virus.
    • Infected health care workers must comply with the requirements of their professional boards.

    Hispanic Americans And Hepatitis B

    Adult Hispanic Americans have a low rate of chronic hepatitis B infection, according to CDC statistics, and they die from hepatitis Brelated causes at the same rate as adult white Americans. Among adults ages 19 to 49, vaccination coverage was lower for Hispanic than for white Americans in 2015, but among Hispanic and white adolescents ages 1317 years and children age 19 to 35 months, it was the same in 2016.

    Read Also: What Is The Difference Between Hepatitis B And Hepatitis C

    How Does It Affect The Body

    The incubation period for hepatitis B can range from . However, not everyone who has acute hepatitis B will experience symptoms.

    About 95 percent of adults completely recover from hepatitis B. However, hepatitis B can also become chronic.

    The risk of chronic hepatitis B is greatest in those who were exposed to HBV as young children. Many people with chronic hepatitis B dont have symptoms until significant liver damage has occurred.

    In some people whove had hepatitis B, the virus can reactivate later on. When this happens, symptoms and liver damage may occur. People with a weakened immune system and those being treated for hepatitis C are at a higher risk for HBV reactivation.

    How Is This Vaccine Given

    Hepatitis B: Know the Essentials

    This vaccine is given as an injection into a muscle. You will receive this injection in a doctor’s office or other clinic setting.

    The hepatitis A and B vaccine is given in a series of 3 shots. The booster shots are given 1 month and 6 months after the first shot.

    If you have a high risk of hepatitis infection, you may be given 3 shots within 30 days, and a fourth shot 12 months after the first.

    Your individual booster schedule may be different from these guidelines. Follow your doctor’s instructions or the schedule recommended by the health department of the state you live in.

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    What Are The Risks Of Not Getting The Vaccine

    The main risk of the baby not getting the vaccine is that they may contract the hepatitis B virus.

    Hepatitis B primarily attacks the liver, causing inflammation that can damage this organ over time. An acute infection lasts for less than 6 months and may cause no symptoms in some people.

    Many acute infections resolve without treatment. If the infection persists for 6 months or more, doctors will refer to it as chronic. Chronic infections increase a persons risk of damage to the liver over time.

    As this damage builds up, it can scar the liver, which is known as cirrhosis. This long-term damage may result in other complications, including liver cancer.

    According to the WHO, about

    Cell Attachment Entry Uncoating And Replication

    The mechanism of entry of the HDV into the hepatocytes is not clearly understood, however, it is thought to be similar to HBV. HDV enters hepatocytes by binding to the carbohydrate side chains of heparin sulphate proteoglycan present on the surface of hepatocytes. The N-terminal aminoacids of the pre-S1 domain of L-HBsAg are thus obligatory to HDV entry into hepatocytes. Mutations/deletions in highly conserved pre-S1 sequence and acetylation or myristoylation of pre-S1 N-terminal amino acids have been found to inhibit HDV entry into hepatocytes. Recently, Yan et al have identified a putative receptor for the entry of HBV and HDV into the hepatocytes. The authors proposed that pre-S1 domain of L-HBsAg interacts with sodium-taurocholate cotransporting polypeptide, an integral transmembrane glycoprotein involved in enterohepatic circulation, to facilitate HDV infection.

    After HDV enters the cell, the uncoating of viral particle occurs and HDAg translocates the viral genome into the nucleus where RNA polymerasesIand II are employed to replicate the genome .1). Polymerase I involves the transcription of antigenome from viral genome in the nucleolus, while polymerase II catalyzes genome replication from antigenome and transcription of mRNA in the nucleoplasm.

    Hepatitis D virus replication cycle. HBV: Hepatitis B virus HDV: Hepatitis D virus.

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    What Are Clinical Trials For Hepatitis B

    Clinical trialsand other types of clinical studiesare part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future.

    Researchers are studying many aspects of hepatitis B, such as

    • progression of hepatitis B and long-term outcomes
    • new treatments for hepatitis B
    • prevention of reactivated or worsening hepatitis B in people receiving cancer treatment

    Recommended Adult Dosing Volume Of Monovalent Hepatitis B Vaccine

    Viral hepatitis (A, B, C, D, E) – causes, symptoms, diagnosis, treatment & pathology
    • Age 19 years and younger: Use 0.5 mL per dose .
    • Age 20 years and older: 1.0 mL per dose .

    For a one-page sheet reviewing the hepatitis B dosing schedule for children and adults, consult IACs Hepatitis A and B Vaccines: Be Sure Your Patients Get the Correct Dose. For complete dosing information, consult the ACIP hepatitis B vaccine recommendations for adults.

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    Viral Hepatitis Definition And Overview

    Hepatitis means inflammation of the liver. Many illnesses and conditions can cause inflammation of the liver, for example, drugs, alcohol, chemicals, and autoimmune diseases. Many viruses, for example, the virus causing mononucleosis and the cytomegalovirus, can inflame the liver. Most viruses, however, do not attack primarily the liver the liver is just one of several organs that the viruses affect. When most doctors speak of viral hepatitis, they are using the definition that means hepatitis caused by a few specific viruses that primarily attack the liver and are responsible for about half of all human hepatitis. There are several hepatitis viruses they have been named types A, B, C, D, E, F , and G. As our knowledge of hepatitis viruses grows, it is likely that this alphabetical list will become longer. The most common hepatitis viruses are types A, B, and C. Reference to the hepatitis viruses often occurs in an abbreviated form The focus of this article is on these viruses that cause the majority of human viral hepatitis.

    Hepatitis viruses replicate primarily in the liver cells. This can cause the liver to be unable to perform its functions. The following is a list of major functions of the liver:

    People With Diabetes And Hepatitis B

    CDC has investigated numerous hepatitis B outbreaks in people with diabetes in several settings, including long-term care facilities, hospitals, community health centers, ambulatory surgical centers, private offices, homes, and health fairs. Modes of transmission are believed to have occurred from:

    • use of blood glucose meter for more than one resident without cleaning and disinfection between uses,
    • failure to consistently wear gloves and perform hand hygiene between fingerstick procedures,
    • use of the same fingerstick devices for more than one resident,
    • cross-contamination of clean supplies with contaminated blood glucose monitoring equipment used by home health agencies,
    • use of the same injection equipment such as a syringe or insulin pen for more than one person,
    • failure to maintain separation of clean and contaminated podiatry equipment,
    • improper sterilization of contaminated podiatry equipment, and
    • failure to perform environmental cleaning and disinfection between podiatry patients.

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    What Is Hepatitis D Symptoms Causes Diagnosis Treatment And Prevention

    Hepatitis D, also known as delta hepatitis affects only those who have been exposed to the hepatitis B virus if you contract both, the one-two punch can cause serious liver problems.

    The hepatitis D virus depends on another virus, namely the one that causes hepatitis B, to reproduce itself. This means hepatitis D can only infect people who are already infected with the hepatitis B virus, or who are exposed to hepatitis B at the same time theyre exposed to hepatitis D.

    When you are infected with hepatitis B and D at the same time, its called coinfection.

    If you already have chronic hepatitis B and are then exposed to the hepatitis D virus, its called a superinfection. In either case, this double whammy can lead to serious problems.

    Hepatitis D can cause significant liver damage and even death, so prevention of this dual infection is crucial.

    Hepatitis D can cause an acute or chronic infection, or both. The acute infection lasts a short time, and the chronic infection lasts longer than six months.

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