Hepatitis D

It spreads like hepatitis B: through contact with infected blood or body fluids, such as shared needles or razors, unsafe medical or dental procedures, unprotected sex, or from mother to baby. It can be caught at the same time as hepatitis B (co-infection) or by someone who already carries hepatitis B (superinfection). It is not spread by casual contact, food or water.

Hepatitis D is much less common than hepatitis B, and is more frequent in certain regions of the world. It is often under-diagnosed because many people with hepatitis B are never tested for it.

Anyone with hepatitis B should be considered for a hepatitis D antibody test. If positive, a blood test for HDV RNA shows whether the virus is active. Doctors also assess liver scarring using blood tests, FibroScan (an ultrasound-based stiffness test) and sometimes imaging or biopsy, and check for complications of cirrhosis.

Protecting your liver and others is central.

• Avoid alcohol completely

• Do not share razors, toothbrushes, needles or nail tools

• Use condoms unless your partner is vaccinated against hepatitis B

• Cover cuts and clean blood spills with household bleach and gloves

• Keep all follow-up appointments and regular liver checks

A healthy, balanced diet supports the liver.

• Eat a balanced diet with enough protein, fruit and vegetables

• Limit salt if you have fluid build-up

• Avoid raw shellfish if you have advanced liver disease

• Avoid herbal and supplement products unless your doctor approves

Treatment is decided by a liver specialist, depending on virus activity and liver scarring.

• Medicines that target hepatitis D, including newer options, may be offered where available

• Interferon-type injections have been used in some patients

• Treatment of the underlying hepatitis B with antiviral tablets is often continued

• Do not stop any hepatitis B medicine without your doctor's advice

Which medicine suits you, and for how long, is your doctor's decision.

Procedures are used to monitor or treat complications.

• Regular ultrasound (with or without blood tests) to look for liver cancer if you have cirrhosis or other risk

• Endoscopy to check for swollen veins in cirrhosis

• Liver transplant assessment for advanced disease or liver failure

The course varies. Without treatment, hepatitis D can lead to cirrhosis and liver cancer more often than hepatitis B alone, so regular follow-up matters. Newer treatments have improved the options, and early care with a liver specialist gives the best outcomes.

• Is my hepatitis D virus active, and how much liver scarring do I have?

• Do I need treatment now?

• How often do I need ultrasound and blood tests?

• Should my family be tested and vaccinated?

• Which medicines should I avoid?

This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the Approved for publication by SGA; individual clinician review is ongoing. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.