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Diagnosis of hepatitis D virus infection

INTRODUCTION

The hepatitis D virus (HDV, also called the delta virus) is a defective pathogen that requires the presence of the hepatitis B virus (HBV) for infection. The HD virion is composed of an outer lipoprotein envelope made of the surface antigen of the HBV (HBsAg) and an inner ribonucleoprotein structure in which the HDV genome resides. The HDV genome consists of a single stranded RNA which is folded as a rod-like structure through internal base-pairing (figure 1). It is complexed with the only HDV-encoded antigen, the HDAg [1]. (See "Pathogenesis, epidemiology, natural history, and clinical manifestations of hepatitis D virus infection".)

HDAg can elicit a specific immune response in the infected host, consisting of antibodies of the IgM and IgG class (anti-HDV). In HDV infected individuals, the timing of appearance and level of HDV RNA, HDAg, and anti-HDV in serum allow the three HDV-related clinical entities to be discriminated:

  • Acute HBV/HDV coinfection
  • Acute HDV superinfection of a chronic HBV carrier
  • Chronic HDV infection

(See "Pathogenesis, epidemiology, natural history, and clinical manifestations of hepatitis D virus infection".)

DIAGNOSIS OF HDV INFECTION

Due to the dependence of HDV on HBV, the presence of HBsAg is necessary for the diagnosis of HDV infection. The additional presence of IgM antibody to hepatitis B core antigen (IgM anti-HBc) is necessary for the diagnosis of acute HBV/HDV coinfection (table 1).

         

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Literature review current through: Jun 2014. | This topic last updated: Apr 8, 2014.
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References
Top
  1. Taylor J, Negro F, Rizzetto M. Hepatitis delta virus: From structure to disease expression. Rev Med Virol 1992; 2:161.
  2. Aragona M, Macagno S, Caredda F, et al. Serological response to the hepatitis delta virus in hepatitis D. Lancet 1987; 1:478.
  3. Govindarajan S, Valinluck B, Peters L. Relapse of acute B viral hepatitis--role of delta agent. Gut 1986; 27:19.
  4. Shattock AG, Morgan BM. Sensitive enzyme immunoassay for the detection of delta antigen and anti-delta, using serum as the delta antigen source. J Med Virol 1984; 13:73.
  5. Buti M, Esteban R, Jardí R, et al. Serological diagnosis of acute delta hepatitis. J Med Virol 1986; 18:81.
  6. Grippon P, Ribiere O, Cadranel JF, et al. Long-term delta antigenaemia without appearance of delta antibody in two immunodeficient patients. Lancet 1987; 1:1031.
  7. Bonino F, Heermann KH, Rizzetto M, Gerlich WH. Hepatitis delta virus: protein composition of delta antigen and its hepatitis B virus-derived envelope. J Virol 1986; 58:945.
  8. Buti M, Esteban R, Jardi R, et al. Chronic delta hepatitis: detection of hepatitis delta virus antigen in serum by immunoblot and correlation with other markers of delta viral replication. Hepatology 1989; 10:907.
  9. Negro F, Bergmann KF, Baroudy BM, et al. Chronic hepatitis D virus (HDV) infection in hepatitis B virus carrier chimpanzees experimentally superinfected with HDV. J Infect Dis 1988; 158:151.
  10. Buti M, Esteban R, Roggendorf M, et al. Hepatitis D virus RNA in acute delta infection: serological profile and correlation with other markers of hepatitis D virus infection. Hepatology 1988; 8:1125.
  11. Zignego AL, Dubois F, Samuel D, et al. Serum hepatitis delta virus RNA in patients with delta hepatitis and in liver graft recipients. J Hepatol 1990; 11:102.
  12. Zignego AL, Deny P, Feray C, et al. Amplification of hepatitis delta virus RNA sequences by polymerase chain reaction: a tool for viral detection and cloning. Mol Cell Probes 1990; 4:43.
  13. Madejón A, Castillo I, Bartolomé J, et al. Detection of HDV-RNA by PCR in serum of patients with chronic HDV infection. J Hepatol 1990; 11:381.
  14. Cariani E, Ravaggi A, Puoti M, et al. Evaluation of hepatitis delta virus RNA levels during interferon therapy by analysis of polymerase chain reaction products with a nonradioisotopic hybridization assay. Hepatology 1992; 15:685.
  15. Dinolfo L, Abate ML, Bertolo P, et al. Detection of hepatitis D virus RNA in serum by a reverse transcription, polymerase chain reaction-based assay. Int J Clin Lab Res 1995; 25:35.
  16. Wu JC, Chen TZ, Huang YS, et al. Natural history of hepatitis D viral superinfection: significance of viremia detected by polymerase chain reaction. Gastroenterology 1995; 108:796.
  17. Mederacke I, Bremer B, Heidrich B, et al. Establishment of a novel quantitative hepatitis D virus (HDV) RNA assay using the Cobas TaqMan platform to study HDV RNA kinetics. J Clin Microbiol 2010; 48:2022.
  18. Schaper M, Rodriguez-Frias F, Jardi R, et al. Quantitative longitudinal evaluations of hepatitis delta virus RNA and hepatitis B virus DNA shows a dynamic, complex replicative profile in chronic hepatitis B and D. J Hepatol 2010; 52:658.
  19. Negro F, Rizzetto M. Diagnosis of hepatitis delta virus infection. J Hepatol 1995; 22:136.
  20. Casey JL, Brown TL, Colan EJ, et al. A genotype of hepatitis D virus that occurs in northern South America. Proc Natl Acad Sci U S A 1993; 90:9016.
  21. Wu JC, Choo KB, Chen CM, et al. Genotyping of hepatitis D virus by restriction-fragment length polymorphism and relation to outcome of hepatitis D. Lancet 1995; 346:939.
  22. Casey JL, Niro GA, Engle RE, et al. Hepatitis B virus (HBV)/hepatitis D virus (HDV) coinfection in outbreaks of acute hepatitis in the Peruvian Amazon basin: the roles of HDV genotype III and HBV genotype F. J Infect Dis 1996; 174:920.
  23. Niro GA, Smedile A, Andriulli A, et al. The predominance of hepatitis delta virus genotype I among chronically infected Italian patients. Hepatology 1997; 25:728.
  24. Dény P. Hepatitis delta virus genetic variability: from genotypes I, II, III to eight major clades? Curr Top Microbiol Immunol 2006; 307:151.
  25. Niro GA, Casey JL, Gravinese E, et al. Intrafamilial transmission of hepatitis delta virus: molecular evidence. J Hepatol 1999; 30:564.
  26. Huang YH, Wu JC, Lu SN, et al. Phylogenetic analysis to document a common source of hepatitis D virus infection in a mother and her child. Zhonghua Yi Xue Za Zhi (Taipei) 1999; 62:28.
  27. Smedile A, Lavarini C, Crivelli O, et al. Radioimmunoassay detection of IgM antibodies to the HBV-associated delta (delta) antigen:" clinical significance in delta infection. J Med Virol 1982; 9:131.
  28. Borghesio E, Rosina F, Smedile A, et al. Serum immunoglobulin M antibody to hepatitis D as a surrogate marker of hepatitis D in interferon-treated patients and in patients who underwent liver transplantation. Hepatology 1998; 27:873.
  29. Di Bisceglie AM, Negro F. Diagnosis of hepatitis delta virus infection. Hepatology 1989; 10:1014.
  30. Bonino F, Negro F, Baldi M, et al. The natural history of chronic delta hepatitis. In: The hepatitis delta virus and its infection, Rizzetto M, Gerin JL, Purcell RH (Eds), Alan R Liss, New York 1987. p.145.