Hepatitis D

Hepatitis D is infection with hepatitis D virus (HDV), a subviral agent that depends on HBV for entry into hepatocytes and for assembly and secretion of new virions ^[3][2]. The infection therefore occurs only in the setting of HBV coinfection or superinfection ^[3][2]. As summarized in the literature, HDV is a viral hepatitis entity of major public-health importance because of its association with progressive liver disease and its dependence on HBV epidemiology ^[3][4].

Clinical severity is strongly shaped by the pattern of HBV association. Acute HDV-HBV coinfection is followed by clearance of both viruses in approximately 95% of people, whereas HDV superinfection on chronic HBV infection leads to chronic HDV-HBV infection in more than 90% of infected patients ^[3]. Chronic hepatitis D is reported to cause more rapidly progressive liver disease than HBV alone, with more rapid progression to cirrhosis and higher rates of hepatocellular carcinoma ^[3]. In one review, approximately 30% to 70% of patients with chronic hepatitis D had cirrhosis at diagnosis and more than 50% died of liver disease within 10 years, although more recent studies suggest that progression can be variable and that more than 50% of people may have an indolent course ^[3].

Available estimates suggest wide global distribution, with HDV infection affecting approximately 12 million to 72 million people worldwide and an estimated 12.0 million anti-HDV-positive people globally in one meta-analysis ^[3][4]. In the same analysis, anti-HDV prevalence among HBsAg-positive people was estimated at 4.5%, and it was higher in hepatology clinic populations at 16.4% ^[4]. Prevalence among HBsAg-positive people was reported to be highest in Mongolia, the Republic of Moldova, and countries in Western and Middle Africa ^[4]. The literature also notes higher prevalence in injecting drug users, haemodialysis recipients, men who have sex with men, commercial sex workers, and people with HCV or HIV ^[4]. Surveillance interpretation is complicated by underdiagnosis, with only about 20% to 50% of infected people diagnosed because of limited awareness and limited access to reliable HDV antibody and HDV RNA testing ^[3].

Transmission of HDV occurs in association with HBV exposure and mirrors HBV-associated routes, including coinfection with HBV or superinfection of a person with chronic HBV infection or carrier state ^[2][3]. The reviewed literature further describes greater occurrence in populations with exposures such as injecting drug use and receipt of clotting factor concentrates, indicating that blood-associated routes are epidemiologically important ^[2]. Because HDV requires HBV to enter hepatocytes and produce infectious virions, HBV epidemiology is integral to HDV transmission dynamics ^[3][2].

Source-backed higher-prevalence groups include people with HBV infection, especially those with chronic HBV or carrier state, because HDV requires HBV for propagation ^[3][2]. The literature also identifies injecting drug users, haemodialysis recipients, men who have sex with men, commercial sex workers, and people with HCV or HIV as groups with higher prevalence ^[4]. Additional exposure-associated groups noted in the sources include persons receiving clotting factor concentrates ^[2].

Prevention is primarily mediated through HBV prevention. The HBV vaccine is reported to prevent HDV infection by preventing HBV infection, but no vaccine is available to protect people who already have established HBV infection against HDV ^[3]. The source material does not provide a more detailed HDV-specific prevention schedule or post-exposure algorithm, so source-backed detail beyond HBV vaccination and prevention of HBV exposure is not yet available ^[3].

In surveillance contexts, hepatitis D should be interpreted as a dependent infection whose burden follows HBV epidemiology and whose detection depends on access to HDV antibody and HDV RNA testing ^[3][4]. The reported burden is likely underestimated because a substantial fraction of infections remain undiagnosed, and prevalence estimates vary by population, with higher levels in HBV-positive clinical and high-risk groups ^[3][4]. Monitoring should therefore focus on HBV-infected populations and on settings where underdiagnosis and severe liver outcomes are more likely to be recognized ^[3][4].

1. 1 Wikidata contributors. hepatitis D [Internet]. Wikidata. cited 20 May 2026. Available from: https://www.wikidata.org/wiki/Q327281
2. 2 Wikipedia contributors. Hepatitis D - Wikipedia [Internet]. Wikipedia. cited 20 May 2026. Available from: https://en.wikipedia.org/wiki/Hepatitis_D
3. 3 Negro F et al. Hepatitis D: A Review. JAMA. 2023 Dec 26. PMID: 37943548. doi: 10.1001/jama.2023.23242. PubMed: https://pubmed.ncbi.nlm.nih.gov/37943548/
4. 4 Stockdale AJ et al. The global prevalence of hepatitis D virus infection: Systematic review and meta-analysis. J Hepatol. 2020 Sep. PMID: 32335166. doi: 10.1016/j.jhep.2020.04.008. PubMed: https://pubmed.ncbi.nlm.nih.gov/32335166/
5. 5 Asandem DA et al. Hepatitis B Virus Infection: A Mini Review. Viruses. 2024 May 3. PMID: 38793606. doi: 10.3390/v16050724. PubMed: https://pubmed.ncbi.nlm.nih.gov/38793606/
6. 6 Hepatitis Viruses: Hepatitis B and Hepatitis D. Viral Infections of Humans. 2022. doi: 10.1007/978-1-4939-9544-8_32-1. DOI: https://doi.org/10.1007/978-1-4939-9544-8_32-1

ICD-10

B17.0

ICD-11

1E50.3

Total cases

5K

Peak month

2017-09

Coverage

4 reporting countries · 2000-01-01 → 2021-08-01