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Hepatitis D

Disease Details

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Description: Hepatitis D is a liver infection caused by the hepatitis D virus (HDV), which only occurs in individuals who are already infected with hepatitis B virus (HBV).
Type: Hepatitis D is a type of viral infection caused by the hepatitis D virus (HDV). It is not transmitted genetically but rather through parenteral routes, which include exposure to infected blood, sexual contact, and from mother to child during childbirth. HDV infection requires the presence of the hepatitis B virus (HBV) to replicate, as it is a defective virus that depends on HBV for its propagation.
Signs And Symptoms: Signs and symptoms of Hepatitis D can include:

1. Jaundice (yellowing of the skin and eyes)
2. Fatigue
3. Abdominal pain, particularly in the upper right quadrant
4. Dark urine
5. Pale or clay-colored stools
6. Nausea and vomiting
7. Loss of appetite
8. Joint pain
9. Ascites (accumulation of fluid in the abdomen)
10. Enlarged liver (hepatomegaly)
11. Itchy skin

These symptoms can vary in intensity and may be exacerbated by existing Hepatitis B infection, as Hepatitis D virus (HDV) requires Hepatitis B virus (HBV) for replication.
Prognosis: Superinfections, in which hepatitis D viral infection occurs in someone who has chronic hepatitis B (as opposed to co-infection, in which a person is infected with hepatitis B and D simultaneously), are more likely to progress to chronic hepatitis D and are associated with a worse prognosis. 90% of cases of chronic hepatitis D infection are thought to be due to superinfection in those already with hepatitis B. Hepatitis B and D co-infection is likely to lead to acute hepatitis, but is usually self limited with regards to the hepatitis D infection. Chronic hepatitis B and D is associated with a worse prognosis than chronic hepatitis B alone. Infection with both viruses is characterized by a poor prognosis with 75% of those with chronic hepatitis D developing liver cirrhosis within 15 years and a much higher risk of developing liver cancer. Persistent HDV viremia is the most important risk factor for disease progression in those with co-infection or superinfection. Other factors that are responsible for a poor prognosis in chronic hepatitis D include male sex, older age at time of infection, alcohol use, diabetes, obesity and immunodeficiency.
Onset: Hepatitis D, also known as hepatitis delta, is a liver infection caused by the hepatitis D virus (HDV). It occurs only in individuals who are already infected with hepatitis B, as HDV requires the hepatitis B surface antigen to replicate.

- **Onset**: The onset of hepatitis D can vary. In acute co-infection with hepatitis B, symptoms may appear within 3 to 7 weeks. In chronic hepatitis B patients who acquire HDV superinfection, an acute flare of hepatitis can occur within 2 to 8 weeks.

- **Nan**: The term "nan" typically stands for "not a number" and is not relevant in the context of hepatitis D clinical features or diagnosis. If you meant to ask about a specific aspect such as diagnosis, transmission, or treatment instead, please clarify.
Prevalence: The exact prevalence of Hepatitis D (HDV or Hepatitis Delta Virus) is difficult to determine due to variations in reporting and the co-infection with Hepatitis B Virus (HBV). However, it is estimated that approximately 15-20 million people worldwide are infected with HDV. Prevalence rates vary significantly by region, with higher rates observed in parts of Africa, the Middle East, southern Italy, the Amazon Basin, and parts of Asia.
Epidemiology: HDV is prevalent worldwide. However, the prevalence is decreasing in many higher income countries due to hepatitis B vaccination programs (although rates remain high in some groups such as those who inject drugs or immigrants from HDV endemic reigions). Infection with HDV is a major medical scourge in low income regions of the globe in which HBV prevalence remains high. Currently the Amazon basin and low income regions of Asia and Africa have high rates of HDV, owing to concurrently high rates of HBV. Globally, five percent of those with chronic hepatitis B infection also have hepatitis D and 12.5% of people with HIV are also co-infected with hepatitis D.
Intractability: Hepatitis D, also known as Hepatitis Delta, can be challenging to treat. It requires the presence of Hepatitis B to replicate, making its management more complex. Current treatment options are limited and often not highly effective. Pegylated interferon is the primary treatment; however, it has varied success rates and significant side effects. Advancements in antiviral therapies are ongoing, but as of now, the disease remains difficult to manage and control effectively.
Disease Severity: Hepatitis D, also known as hepatitis delta, is a severe liver infection caused by the hepatitis D virus (HDV).

**Disease Severity:**
Hepatitis D can lead to serious liver damage and is considered one of the most severe forms of viral hepatitis. It can cause rapid progression to liver cirrhosis, liver failure, and hepatocellular carcinoma (liver cancer), especially in individuals co-infected with hepatitis B. The co-infection can be either simultaneous (acute co-infection) or superinfection (HDV infecting an individual already chronically infected with HBV), with superinfection generally leading to more severe outcomes.

**Nan:**
The term "nan" generally stands for "not a number" in computational contexts, but if you're inquiring about a biological aspect like nanoparticles in the treatment or diagnosis of hepatitis D, there is currently no established role of nanoparticles specific to hepatitis D management. Research in nanotechnology for liver diseases is ongoing, but no specific nanotechnology-based therapies are approved for hepatitis D as of now.
Healthcare Professionals: Disease Ontology ID - DOID:2047
Pathophysiology: Pathophysiology of Hepatitis D:

Hepatitis D, also known as Hepatitis Delta, is caused by the Hepatitis D virus (HDV), which is a defective virus that requires the presence of Hepatitis B virus (HBV) to replicate. The co-infection or superinfection with HBV and HDV leads to more severe liver disease compared to HBV infection alone.

1. **Entry and Replication**: HDV enters hepatocytes (liver cells) through the same receptor as HBV. It uses the HBV surface antigen (HBsAg) to penetrate cells. Once inside, HDV exploits the host cell machinery to replicate its RNA.

2. **Immune Response and Inflammation**: The presence of both HDV and HBV triggers a robust immune response. Cytotoxic T cells and other immune cells target infected hepatocytes, leading to liver cell damage and inflammation, known as hepatitis.

3. **Fibrosis and Cirrhosis**: Chronic HDV infection can lead to progressive liver fibrosis as the liver attempts to repair itself. Persistent inflammation and injury can result in cirrhosis, where the liver tissue becomes scarred and its functionality is impaired.

4. **Clinical Manifestations**: The interplay between HDV and HBV can accelerate disease progression, leading to more severe outcomes such as liver failure, hepatocellular carcinoma, and decompensated cirrhosis.

Disease progression and severity vary based on whether HDV infection occurs simultaneously with HBV (co-infection) or in a person already chronically infected with HBV (superinfection). Superinfection typically results in a more severe disease course.

Understanding the pathophysiology of Hepatitis D is crucial for developing effective treatments and managing the disease to prevent advanced liver damage and associated complications.
Carrier Status: Hepatitis D, also known as delta hepatitis, is caused by the Hepatitis D Virus (HDV), which requires the presence of Hepatitis B Virus (HBV) for its replication. Carrier status for hepatitis D occurs when an individual is chronically infected with both HBV and HDV. This co-infection can lead to more severe liver disease compared to HBV infection alone. Managing carrier status typically involves antiviral treatments aimed at controlling HBV replication since there is no specific antiviral treatment for HDV. Regular monitoring and liver function tests are essential for managing health outcomes in carriers.
Mechanism: Hepatitis D, also known as hepatitis delta, is caused by the hepatitis D virus (HDV). HDV is a unique virus that requires the presence of hepatitis B virus (HBV) to replicate and propagate. Here are the mechanisms and molecular mechanisms involved in HDV infection:

### Mechanism:
1. **Co-infection or Superinfection**:
- **Co-infection**: Occurs simultaneously with HBV infection.
- **Superinfection**: Occurs in individuals who are already chronically infected with HBV.

2. **Viral Entry**: HDV enters hepatocytes (liver cells) using the same receptor as HBV, the sodium taurocholate co-transporting polypeptide (NTCP).

3. **Replication**: HDV cannot produce its own surface proteins and uses the HBV surface antigen (HBsAg) to form the viral envelope.

4. **Pathogenesis**: HDV exacerbates liver damage caused by HBV due to its ability to replicate and induce immune responses, leading to more severe liver injury.

### Molecular Mechanisms:
1. **RNA Genome**: HDV is a small, circular, single-stranded RNA virus. Its genome encodes a single protein, the Hepatitis D Antigen (HDAg), in two forms - the small delta antigen (S-HDAg) and the large delta antigen (L-HDAg).

2. **Dependence on HBV**:
- HDV requires the HBsAg produced by HBV for assembly and secretion of new virions.
- The HDAg interacts with cellular transcription and replication machinery to facilitate HDV replication.

3. **RNA Editing**:
- A process called RNA editing by the host enzyme ADAR1 converts an amber/W-site to the L-HDAg, which inhibits HDV RNA replication and assists in virion assembly.

4. **Immune Response**:
- HDV infection induces a strong immune response, leading to liver inflammation and damage.
- The severity of liver disease in HDV-infected individuals is typically greater compared to HBV alone due to the additional immune-mediated injury.

5. **Interference with HBV**:
- HDV can alter the HBV life cycle and suppress HBV replication.
- This interaction can complicate the clinical course of the dual infection.

Understanding these mechanisms provides insight into the challenges in treating and managing hepatitis D, emphasizing the need for innovative therapeutic approaches targeting both HDV and HBV simultaneously.
Treatment: Current established treatments for chronic hepatitis D include conventional or pegylated interferon alpha therapy. Evidence suggests that pegylated interferon alpha is effective in reducing the viral load and the effect of the disease during the time the drug is given, but the benefit generally stops if the drug is discontinued. The efficiency of this treatment does not usually exceed about 20%, and late relapse after therapy has been reported.In May 2020, the Committee for Medicinal Products for Human Use of the European Medicines Agency approved the antiviral Hepcludex (bulevirtide) to treat hepatitis D. Bulevirtide binds and inactivates the sodium/bile acid cotransporter, blocking hepatitis D virus (as well as hepatitis B virus) from entering hepatocytes. Bulevirtide may be given with pegylated interferon alpha as the two are thought to have a synergistic effect, leading to greater treatment response rates.In patients with HDV-related compensated Cirrhosis and clinically significant portal hypertension, the treatment with (bulevirtide) was safe, well tolerated and has led to a significant improvement in biochemical variables and an increase in liver function parameters.Other treatments for hepatitis D which are currently under development include pegylated interferon lambda (λ), which binds to receptors on the hepatocyte surface leading to an intracellular signaling cascade via the JAK-STAT signaling pathway and activation of anti-viral cell mediated immunity. The prenylation inhibitor lonafarnib prevents hepatitis D viral particle assembly by inhibiting the farnesylation of the L-HDAg. REP2139-Ca is a nucleic acid polymer that prevents the release of hepatitis B surface antigen (which is required for assembly of hepatitis D viral particles).
Compassionate Use Treatment: Hepatitis D (Hepatitis Delta) is a serious liver disease caused by the hepatitis D virus (HDV). For compassionate use and experimental treatments, several options exist:

1. **Bulevirtide**: This is a promising antiviral agent specifically for HDV. It received conditional marketing approval in Europe and is available for compassionate use in some regions.

2. **Lonafarnib**: Another investigational drug, Lonafarnib is an oral prenylation inhibitor that has shown efficacy in reducing HDV RNA levels. It is currently in clinical trials.

3. **Interferon-alpha**: Though not specifically labeled for HDV, pegylated interferon-alpha has been used off-label for HDV treatment. The response rates have been variable, and it requires prolonged administration.

4. **Nucleotide analogs**: Some nucleos(t)ide analogs like Tenofovir and Entecavir, which are typically used for Hepatitis B, are also sometimes used off-label in HDV co-infected patients, though their efficacy specifically against HDV is limited.

These options underscore the ongoing need for effective treatments and are usually considered for patients with severe disease or those who do not respond to conventional therapies.
Lifestyle Recommendations: For individuals with hepatitis D, the following lifestyle recommendations may help manage the condition and improve overall health:

1. **Avoid Alcohol:** Alcohol can further damage the liver, so complete avoidance is crucial.
2. **Healthy Diet:** Consume a balanced diet rich in fruits, vegetables, lean proteins, and whole grains to support liver health.
3. **Regular Exercise:** Engage in moderate physical activity to maintain a healthy weight and overall well-being.
4. **Avoid Random Medications:** Always consult with a healthcare provider before taking new medications or supplements to avoid liver toxicity.
5. **Practice Safe Sex:** Use protection to reduce the risk of transmitting or acquiring additional infections.
6. **Avoid Sharing Needles:** If you use intravenous drugs, avoid sharing needles to prevent transmission of hepatitis and other infections.
7. **Vaccination:** Get vaccinated against hepatitis B, as co-infection with hepatitis B and D can lead to more severe liver disease.
8. **Regular Medical Follow-up:** Keep up with regular appointments to monitor liver function and overall health.

These recommendations can help manage hepatitis D and protect liver health. It's important to consult healthcare professionals for personalized advice.
Medication: Hepatitis D, or Hepatitis Delta, often requires medication such as antiviral drugs. Interferon alfa is the primary treatment used. Combination therapies with other antivirals are being researched. It is important to monitor liver function and consult a healthcare provider for an appropriate treatment plan.
Repurposable Drugs: For Hepatitis D, some of the drugs that are being explored for repurposing include:

1. **Pegylated Interferon-alpha (PEG-IFN-α)**: Originally used for Hepatitis B and C, this drug has shown some efficacy in treating Hepatitis D by modulating the immune response.

2. **Tenofovir**: Primarily an anti-HIV medication, Tenofovir has been explored for its potential to reduce Hepatitis D viral load, especially in co-infections with Hepatitis B.

3. **Lonafarnib**: This drug, originally developed for other purposes, is an inhibitor of farnesyl transferase and has shown promise in reducing HDV replication.

These repurposable drugs are under investigation and offer hope for more effective management of Hepatitis D.
Metabolites: Hepatitis D, also known as hepatitis delta virus (HDV) infection, is a liver disease that occurs only in individuals who are also infected with hepatitis B virus (HBV). Here are some relevant points about the metabolites and analyses regarding this condition:

1. **Metabolites:**
- The specific metabolic profile associated with hepatitis D has not been extensively characterized independently of other liver diseases, especially hepatitis B.
- General liver dysfunction metabolites such as elevated bilirubin, ammonia, and liver enzymes (ALT, AST) may be observed, similar to other types of hepatitis.

2. **Nan:**
- "Nan" could be referring to nanotechnology-based approaches in the context of hepatitis D, although it's not a established term in this context.
- Advances in nanotechnology could aid in the diagnosis and treatment of hepatitis D through the development of nanoscale drug delivery systems or advanced diagnostic tools, although such applications are still largely in the research phase.

For detailed and specific information, further clinical data and research literature would be necessary.
Nutraceuticals: For Hepatitis D, there is currently no specific nutraceutical known to effectively treat the disease. Management primarily focuses on antiviral treatments and supporting liver health through a balanced diet and avoiding alcohol and drugs that can harm the liver. Consultation with a healthcare provider is crucial for a tailored treatment plan.
Peptides: Hepatitis D, also known as hepatitis delta, is caused by the hepatitis D virus (HDV). It is a unique RNA virus that requires the hepatitis B virus (HBV) surface antigen (HBsAg) to propagate.

Current research into HDV includes the use of peptide-based therapies and nanotechnology to improve treatment and diagnostic options. Peptide inhibitors target viral entry, replication, or assembly processes, while nanotechnology may enhance drug delivery, improve diagnostic accuracy, or create more effective vaccines by enabling targeted delivery and controlled release of therapeutic agents at the molecular level.