19. Hepatitis D

  1. James S. Dooley MD, FRCP2,3,
  2. Anna S. F. Lok MBBS, MD, FRCP4,
  3. Andrew K. Burroughs FRCP, FMedSci3,5 and
  4. E. Jenny Heathcote MB BS, MD, FRCP, FRCP(C)6,7
  1. Patrizia Farci MD

Published Online: 5 MAY 2011

DOI: 10.1002/9781444341294.ch19

Sherlock's Diseases of the Liver and Biliary System, 12th Edition

Sherlock's Diseases of the Liver and Biliary System, 12th Edition

How to Cite

Farci, P. (2011) Hepatitis D, in Sherlock's Diseases of the Liver and Biliary System, 12th Edition (eds J. S. Dooley, A. S. F. Lok, A. K. Burroughs and E. J. Heathcote), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444341294.ch19

Editor Information

  1. 2

    Centre for Hepatology, University College London Medical School, UK

  2. 3

    Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK

  3. 4

    Division of Gastroenterology, University of Michigan Health System, Ann Arbor, MI, USA

  4. 5

    University College London, London, UK

  5. 6

    Division of Gastroenterology, University Health Network, University of Toronto, Toronto, Ontario, Canada

  6. 7

    Patient Based Clinical Research, Toronto Western Hospital Research Institute, Toronto, Ontario, Canada

Author Information

  1. Hepatic Pathogenesis Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA

Publication History

  1. Published Online: 5 MAY 2011
  2. Published Print: 25 APR 2011

ISBN Information

Print ISBN: 9781405134897

Online ISBN: 9781444341294



  • hepatitis delta virus;
  • acute hepatitis D;
  • chronic hepatitis D;
  • coinfection;
  • superinfection;
  • HDV RNA;
  • standard interferon-α;
  • pegylated interferon-α


Hepatitis D virus (HDV) is a defective RNA virus that uses the HBsAg of hepatitis B virus (HBV) as its envelope protein. Thus, HDV infection can occur only by simultaneous coinfection with HBV or by superinfection of a chronic HBsAg carrier. It is estimated that 15 million HBsAg carriers are coinfected with HDV worldwide. HDV is highly pathogenic. Acute hepatitis D is often severe or even fulminant. Chronic hepatitis D is less common than chronic hepatitis B or C but more severe and rapidly progressive, leading to cirrhosis in most cases. Better control of HBV has led to a dramatic decline of HDV in developed countries where long-standing infections, many already progressed to cirrhosis, are now predominant. However, immigration from endemic areas is causing a resurgence of HDV and new foci are emerging, especially in developing countries. The only approved therapy for chronic hepatitis D is interferon-α, but treatment remains unsatisfactory, emphasizing the need for novel therapeutic approaches.