Hepatitis D: how it relates to hepatitis B, risks and treatment

Hepatitis means inflammation of the liver. Hepatitis D is caused by a virus that Liver UK describes as rare and affecting the liver. It is unusual among hepatitis viruses because it can only cause infection in someone who already has hepatitis B.

It is much less common than hepatitis B. Liver UK says that globally fewer than 5 out of 100 people living with hepatitis B are estimated to also have hepatitis D, and that in the UK about 160 people a year are diagnosed.

Hepatitis D can make hepatitis B worse. Liver UK says people living with both viruses are more likely to get advanced scarring of the liver (cirrhosis) or liver cancer than people with hepatitis B only. Not everyone with hepatitis D gets serious liver disease, and treatment for hepatitis B and D reduces the chance of it.

For this reason Liver UK recommends that anyone with hepatitis B should be tested for hepatitis D, so that the extra risk is identified and monitoring and treatment can be planned.

The NHS says hepatitis B is a liver infection spread through blood and body fluids. Ways of getting it include sex without a condom or dam, injecting drugs with shared needles, being injured by a used needle, having a tattoo, piercing or medical or dental procedure with unsterilised equipment, and having a blood transfusion in a country that does not check blood for hepatitis B. Blood transfusions in the UK are checked, and the NHS says donated blood has been tested for hepatitis B since 1972.

A pregnant person with hepatitis B can pass it to the baby at birth, and babies born to mothers with hepatitis B are given additional vaccinations to reduce the risk of infection, the NHS says. The NHS names higher-risk areas of the world, including sub-Saharan Africa, Asia and the Pacific islands, the Middle East, parts of South America and southern parts of central and eastern Europe.

The NHS says most people with hepatitis B either have no symptoms or mild symptoms. If symptoms occur they can include a high temperature, tiredness, upper tummy pain, feeling or being sick, an itchy raised rash, yellowing of the skin and whites of the eyes (jaundice), darker urine and pale poo. Because hepatitis D occurs on top of hepatitis B, many people are found through testing rather than symptoms, which is why the advice is to test everyone who has hepatitis B.

The NHS advises seeing a GP if you think you might have hepatitis B or are at high risk of getting it.

Liver UK says that the main hepatitis D treatment for many years has been pegylated interferon, which is sometimes used to treat hepatitis B too. In 2023 a new treatment, bulevirtide, was approved for use in the UK. Treatments cannot yet get rid of the virus, but they can manage it so that it does less damage.

For the hepatitis B infection that underlies it, the NHS says chronic hepatitis B has no known cure and is usually treated with antivirals and medicines to control the virus and relieve symptoms, with regular check-ups with a liver specialist. The NHS also says not to drink alcohol if you have hepatitis B, to avoid sex without a condom or dam, and not to share razors, toothbrushes or needles.

Since hepatitis D needs hepatitis B to infect, preventing hepatitis B prevents hepatitis D. The NHS says that in the UK the hepatitis B vaccine is given to babies as part of the 6-in-1 vaccine, and that adults only need it if they are at high risk, for example if travelling to a high-risk country, if they have liver or kidney disease or HIV, inject drugs or are a close contact of someone who does, have multiple sexual partners, are a man who has sex with men, or have a job that puts them at risk, such as a healthcare worker or prison worker.

The NHS says your employer should organise vaccination if your job puts you at risk, and that you may have to pay for a travel vaccine. Condoms or dams and not sharing razors, toothbrushes or needles help to lower the risk.

People with chronic hepatitis B are seen regularly by a liver specialist for monitoring. Liver UK offers a page on living with hepatitis D and on support, and a nurse-led helpline for people with liver conditions.

Hepatitis B and D are managed through NHS hepatology or infectious disease services after GP referral.

Private hepatology provides access to the same tests, with results to be shared with your GP and liver team so monitoring stays coordinated.