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Hepatitis D and E

Hepatitis D and E

Hepatitis D and E

Craig V. Towers, M.D., & Patricia D. Hastings, RN, BSN, MSN
Craig V. Towers, M.D., & Patricia D. Hastings, RN, BSN, MSN
on behalf of e-Ed Credits

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Launch date: 19 Sep 2017
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Last updated: 11 Jan 2018

Reference: 184801

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The first virus identified that caused hepatitis, was Hepatitis B, discovered in 1965. This was followed a few years later by the discovery of Hepatitis A in 1973. The Hepatitis D virus (HDV) or delta agent was the third hepatitis virus discovered. The first report on HDV was by Rizzetto and colleagues in Italy in 1977. The virus was identified within the liver cell of a patient who had hepatitis B, but it was distinct from the hepatitis B viral DNA (deoxyribonucleic acid). The viral particle was eventually found to be a defective RNA (ribonucleic acid) virus that was 35 to 37 nanometers in diameter but was encapsulated by the hepatitis B surface antigen protein coating. It is considered to be a defective virus because it requires a co-infection with hepatitis B in order to support its replication. It is not seen in the presence of anti-HBsAg (the antibody to the surface antigen of hepatitis B) or as an infection by itself.

Three distinct genotypes have been cloned. Genotype I is the most common and has been found worldwide. Genotype II has primarily been found in Japan and other Asian countries, whereas genotype III is primarily found in South America.

An infection with Hepatitis D can develop in 3 separate ways. It can occur as an acute infection simultaneously with an acute hepatitis B infection; or it can present as an acute infection superimposed upon a chronic hepatitis B infection; and lastly it can be a chronic hepatitis D infection superimposed upon a chronic hepatitis B infection. Hepatitis D appears to compete somewhat with Hepatitis B in these co-infections, because the HBV-DNA titer often decreases when an individual becomes infected with HDV.

Even though this virus has been known for nearly 25 years, the significance of its impact on healthcare is still relatively undefined. One of the reasons for this issue is that the virus cannot exist without a co-infection with Hepatitis B. Therefore, the majority of research has focused on Hepatitis B. However, a combined acute Hepatitis B / Hepatitis D infection will often take on a more fulminant course when compared to an acute hepatitis B virus infection alone. In addition, in patients who have a chronic Hepatitis B / Hepatitis D infection, about 75% will ultimately develop cirrhosis and up to 25% of these will eventually die from hepatic failure.

Patients with chronic Hepatitis B infections are at risk for developing hepatocellular carcinoma in the future. Surprisingly, the patients with hepatocellular carcinoma are usually HDV negative. One explanation for this finding is that HDV may somehow inhibit the development of hepatocellular cancer. However, because patients with chronic HBV / HDV infections often progress to cirrhosis quicker than those who are only HBV infected, another explanation may be that the time needed for developing hepatocellular carcinoma is lacking.


Upon completion of this course, the learner will be able to:
1. Discuss the potential clinical impact of Hepatitis D and Hepatitis E infections and how patients are diagnosed.

2. Describe how Hepatitis D and Hepatitis E are transmitted and discuss the effects of these viral infections on pregnancy and the risk of vertical transmission.

3. Discuss the current treatment options for Hepatitis D and Hepatitis E infected individuals, the limitations of treatment, and the potential for future prevention.
Craig V. Towers, M.D., & Patricia D. Hastings, RN, BSN, MSN

Author Information Play Video Bio

Craig V. Towers, M.D., & Patricia D. Hastings, RN, BSN, MSN
on behalf of e-Ed Credits

Dr. Towers is currently Professor and Vice Chair of the Department of Obstetrics & Gynecology at University of Tennessee Medical Center Knoxville in the Division of Maternal-Fetal Medicine. He is still clinically active managing numerous high-risk pregnancies. He is also actively involved in research with over 90 publications in major medical journals. Though his research has spanned many areas in obstetrics, he has primary interests in drugs in pregnancy, infections in pregnancy, fetal heart monitoring, bleeding in pregnancy, and fetal lung maturity.

He has authored a book for consumers regarding the safety of over-the-counter medications that are used in treating the common cold entitled “I’m Pregnant & I Have a Cold – Are Over-the-Counter Drugs Safe to Use?” published by RBC Press, Inc. He is also one of the new Editors of the reference book for clinical care providers entitled “Drugs in Pregnancy and Lactation, published by Wolters & Kluwer.

Current Accreditations

This course has been certified by or provided by the following Certified Organization/s:

  • American Nurses Credentialing Center (ANCC)
  • 1.00 Hours

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