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Hepatitis D virus infection is transmitted by blood and blood products. The risk factors for infection are similar to those for hepatitis B virus infection. The hepatitis D virus most often infects intravenous drug users.
A patient can acquire hepatitis D virus infection at the same time as he/she is infected with the hepatitis B virus. This is called co-infection. A patient with hepatitis B can be infected with hepatitis D virus at any time after acute hepatitis B virus infection. This is called super-infection.
Hepatitis D virus super-infection should be suspected in a patient with chronic hepatitis B whose condition suddenly worsens. There is usually an obvious history of continued exposure to blood or blood products (eg. an active intravenous drug user). A particularly aggressive acute hepatitis B infection could suggest hepatitis D co-infection. Co-infection or super-infection with hepatitis D virus in a patient with hepatitis B is diagnosed by the presence of antibodies against the hepatitis D virus. IgM antibodies indicate acute infection.
Interferon-alpha is used to treat patients with chronic hepatitis B and hepatitis D infection. Some studies have suggested that a dose higher than that usually used for hepatitis B infection may be beneficial.
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