Hepatitis D
Hepatitis D is a viral infection you can get if you already have a hepatitis B infection. You can also get infected with hepatitis D and hepatitis B at the same time. Hepatitis D affects your liver. Symptoms include fever, abdominal pain, vomiting, dark pee and pale poop or worsening hepatitis B symptoms.
What Is Hepatitis D?
Hepatitis D is a viral infection that causes liver inflammation. You can’t get a hepatitis D infection on its own. You can only get it at the same time as a hepatitis B infection or after you’ve already had hepatitis B.
A hepatitis D infection can be acute or chronic. Symptoms of an acute infection can come on quickly and last for a few weeks or months. Acute infections can become chronic, which means that your symptoms last longer than six months.
Hepatitis D is most common in parts of Africa, Asia, Europe and the Amazon River basin in South America. It’s rare in the U.S. and the rest of North America.
Types of hepatitis D
There are two types of HDV infection:
- Coinfection: A coinfection is when you get infected with hepatitis D virus (HDV) at the same time as hepatitis B virus (HBV).
- Superinfection: A hepatitis D superinfection happens when you already have an HBV infection and you later become infected with hepatitis D. Superinfections are more likely to lead to chronic (long-term) illness.
Hepatitis D causes
Hepatitis virus type D, or HDV, causes hepatitis D. It needs hepatitis B virus (HBV) to survive. You can only get an HDV infection when you already had an HBV infection or at the same time as an HBV infection.
How is hepatitis D transmitted?
You can get hepatitis D if you come in contact with the blood or body fluids of an infected person. Examples of ways hepatitis D can spread include:
- Vaginal, oral and anal sex.
- Sharing needles or syringes.
- Accidental needle sticks.
- Childbirth (you pass the infection to your baby).
Symptoms of hepatitis D
Symptoms of hepatitis D are similar to those of other types of hepatitis. They include:
- Fever.
- Belly (abdominal) pain.
- Nausea and vomiting.
- Loss of appetite.
- Dark pee.
- Pale or gray poop.
- Yellow tinge to your skin or eyes (jaundice).
Hepatitis D can also make existing hepatitis B symptoms worse.
What are the risk factors for hepatitis D?
You can only get hepatitis D if you also have hepatitis B. You’re at a higher risk for hep D if you:
- Inject drugs.
- Have a sex partner who has HBV and HDV.
- Live with someone who has HBV and HDV.
- Have HIV.
- Work in healthcare or another field that puts you in contact with body fluids.
- Are on dialysis.
What are the complications of hepatitis D?
Chronic hepatitis D infection can lead to:
- Liver scarring (cirrhosis).
- Liver failure.
- Hepatocellular carcinoma (a type of liver cancer).
How doctors diagnose hepatitis D
Healthcare providers use blood tests to diagnose hepatitis D. A lab looks for signs of the virus or antibodies to it in your blood. They may also get imaging tests, like an abdominal ultrasound or elastography, to check your liver for signs of scarring.
How is hepatitis D treated?
There’s no treatment that cures hepatitis D. Acute HDV infections can go away without treatment. For chronic hepatitis D, providers may treat you with:
- Peginterferon injections: This is a medication that helps your immune system fight infections.
- Bulevirtide: This antiviral medicationis approved for HDV treatment in certain countries. It’s not approved for use in the U.S.
- Liver transplant: You may need a liver transplant if your liver becomes severely damaged.
Can you prevent hepatitis D?
You can reduce your risk of hepatitis D by getting vaccinated for hepatitis B. There isn’t a vaccine for hepatitis D. If you think you’ve had exposure to hepatitis B, you can still get vaccinated and treated with hepatitis B immune globulin (HBIG).
If you have hepatitis B, you can reduce your risk of getting hepatitis D by:
- Wearing sterile gloves if there’s a chance you’ll touch infected blood, pus or other body fluids.
- Not sharing needles or other equipment for injecting drugs.
- Not sharing personal items like razors and toothbrushes.
- Wearing a condom during any kind of sex.
- Taking antiviral medication to treat hepatitis B.
If you’re pregnant and have hepatitis B or an HBV/HDV infection, healthcare providers can treat your baby after birth to reduce their risk of developing an infection.
What can I expect if I have hepatitis D?
If you have hepatitis D, a healthcare provider will monitor your liver health through regular checkups and testing. They’ll look for signs of liver disease and check your liver function. Acute hepatitis D or HBV/HDV infection can last for a few weeks or months. It may get better without treatment and is rarely fatal.
Most people with a superinfection progress to chronic hepatitis. Chronic hepatitis D lasts six months or longer. Your provider may treat you for a year or longer. Up to 7 in 10 people with chronic HBV/HDV infections will eventually develop liver scarring. This can happen quickly — within the first two years of infection — or take up to 10 years to develop.
How do I take care of myself?
If you have hepatitis, there are steps you can take to reduce your risk of liver damage. These include:
- Avoid alcohol.
- Don’t smoke or quit smoking.
- Maintain a weight that’s healthy for you.
- Ask your provider which over-the-counter (OTC) medications are safe to take.
- Attend all appointments with your healthcare providers and get all recommended tests.
When should I see my healthcare provider?
Talk to your healthcare provider if you have symptoms of hepatitis or if you have hepatitis B and your symptoms suddenly get worse.
When should I go to the ER?
Go to the emergency room if you have these signs of severe illness:
- Severe abdominal pain.
- Severe vomiting or inability to keep anything down.
- Vomiting blood or vomit that looks like coffee grounds.
- Jaundice.
- Confusion or altered mental state.
- Dark-colored pee or peeing very little.
- Clay or light-colored poop.
What’s the difference between hepatitis B and D?
Hepatitis B and D are two different viral infections. But hepatitis D can only infect you at the same time as hepatitis B, or if you already have a hepatitis B infection. Most people with hepatitis B don’t have hepatitis D.
References
- Asselah T, Chulanov V, Lampertico P, et al. Bulevirtide Combined with Pegylated Interferon for Chronic Hepatitis D (https://pubmed.ncbi.nlm.nih.gov/38842520/). N Engl J Med. 2024 Jul;391(2):133-143. Accessed 12/1/2025.
- Centers for Disease Control and Prevention (U.S.). Hepatitis D: CDC Yellow Book 2024 (https://www.cdc.gov/hepatitis-d/about/). Last reviewed 4/24/2024. Accessed 12/1/2025.
- Farci P, Niro GA. Clinical features of hepatitis D (https://pubmed.ncbi.nlm.nih.gov/22932971/). Semin Liver Dis. 2012 Aug;32(3):228-236.Accessed 12/1/2025.
- National Institute of Diabetes and Digestive and Kidney Diseases (U.S.). Hepatitis D (https://www.niddk.nih.gov/health-information/liver-disease/viral-hepatitis/hepatitis-d). Last reviewed 12/2024. Accessed 12/1/2025.
- Sandmann L, Wedemeyer H. Interferon-based treatment of chronic hepatitis D (https://pubmed.ncbi.nlm.nih.gov/36002390/). Liver Int. 2023 Aug;43 Suppl 1:69-79. Accessed 12/1/2025.
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