What is hepatitis D?

Hepatitis D is an inflammation of the liver that is caused by the hepatitis D virus. The unique feature: Hepatitis D viruses cannot multiply on their own, they rely on hepatitis B viruses to do so. A hepatitis D infection can develop very severely.1

Here you can watch a video that explains hepatitis D


  • Around 12 million people worldwide are infected with the hepatitis D virus2,6, some estimates even put the figure at 48-60 million people.7
  • It is thought that some 30,000 people are chronically infected with hepatitis D in Germany.8
  • Nevertheless, there are risk areas such as Mongolia, areas in West and Central Africa, the Mediterranean region, the Middle East, Pakistan, Russia, Brazil and Central and North Asia, all of which have a significantly higher incidence of hepatitis D infections2,7,9
  • Estimates suggest that around 5% of those with hepatitis B also have hepatitis D at the same time.2,6

Hepatitis D viruses, like hepatitis B viruses, can be detected in the blood and other body fluids of infected people. The routes of transmission are also comparable. These include in particular:1,2

  • Unprotected sexual contact (without a condom) with infected partners
  • The use of non-sterile utensils for drug use (needles and sniffing tubes), tattooing or piercing
  • Sharing personal hygiene items, for example razors or nail scissors
  • Childbirth, during which an infected mother can transmit viruses to the child

As already described, a hepatitis D infection can only occur if a person has already contracted hepatitis B. There is a differentiation as to whether the infection occurred at the same time or whether the person concerned already had hepatitis B and only later became infected with the hepatitis D virus additionally.1,3

If a person is infected with the hepatitis D virus and the hepatitis B virus at the same time, it is known as a simultaneous infection.1,3,4 Recovery is usually free of consequences.

The situation is entirely different when a person is already infected with hepatitis B and later also becomes infected with hepatitis D viruses. This case constitutes a superinfection.1,3 It progresses chronically in up to 90% of those affected and results in liver cirrhosis and liver cancer more frequently and more quickly than hepatitis B alone.2,5

Symptoms in the first few weeks of hepatitis D infection typically include fatigue, nausea and vomiting, loss of appetite, fever, lack of concentration, yellowing of the skin and eyes (jaundice), dark urine, light-coloured stools and intense itching.5 The symptoms can vary in severity. Chronic hepatitis D often progresses without symptoms or causes only mild ailments that one does not necessarily associate with the liver.10 This bears the risk of the disease remaining undetected for a long time and progressing to the point where the liver is increasingly damaged. Massive symptoms such as fluid accumulation in the abdominal cavity (ascites) and damage to brain functions are indicative of liver disease in advanced stages of the illness.10

Every person with a confirmed hepatitis B infection should, in principle, also be tested for hepatitis D. In this case, blood is initially tested for antibodies against the hepatitis D virus. If the result is positive – i.e. if antibodies can be detected – then this means that the person either has a current infection with the hepatitis D virus or that an infection occurred in the past and has been resolved/eliminated. This means that a further blood test is necessary to establish whether the infection has been treated or is currently active. The second test then determines whether hepatitis D viruses are still present in the blood. An active infection is present if this test also gives a positive result.4

Hepatitis D can be treated with medication. The objective is to prevent the virus from replicating and in doing so to protect the liver from damage.11 It is best to speak with a doctor to find the best possible treatment and improve the prognosis.

Strange as it may sound at first: One very good way to protect yourself against hepatitis D is to have a hepatitis B vaccination. After all, you can only become infected with the hepatitis D virus if you are also infected with hepatitis B.5 You can also minimise the risk of infection by taking the following measures to avoid contact with infected blood or other bodily fluids such as semen or vaginal secretions as much as possible:1,5,12

  • Safer sex
  • Use sterile equipment for intravenous and nasal drug use and do not share needles with others
  • Ensure sterile working conditions and equipment when tattooing or piercing
  • Do not share personal hygiene products that may be contaminated with blood, such as razors or nail scissors

Share our content

Other topics

Hepatitis B

If you want to find out more about hepatitis B, you can find a lot of useful information here.

Find out more

Hepatitis C

What actually is hepatitis C? Here you will find useful explanations.

Find out more

The liver

Would you like to know more about the liver and what it does? Then you've come to the right place.

Find out more


  1. RKI guide to hepatitis B and D. https://www.rki.de/DE/Content/Infekt/EpidBull/Merkblaetter/Ratgeber_HepatitisB.html (Retrieved May 2022).
  2. Stockdale AJ et al. J Hepatol 2020; 73: 523–532.
  3. Koh C et al. Gastroenterology 2019; 156(2): 461–476.e1.
  4. Cornberg M et al. Z Gastroenterol 2021; 59: 691–776.
  5. Hepatitis D. https://www.who.int/news-room/fact-sheets/detail/hepatitis-d (Retrieved May 2022).
  6. RKI, Epidemiological Bulletin 29/2021.
  7. Miao Z et al. J Infect Dis. 2020; 221(10): 1677–1687.
  8. Hepatitis D Virus. https://www.deutsche-leberstiftung.de/presse/pressemappe/lebererkrankungen/virushepatitis/hepatitis-d/ (Retrieved May 2022).
  9. RKI, Epidemiological Bulletin 29/2019.
  10. Farzi P, Niro GA Semin Liver Dis 2012; 32: 228–236.
  11. Urban S et al. Gut. 2021; 70(9): 1782-1794.
  12. Hepatitis D. https://www.leberhilfe.org/lebererkrankungen/hepatitis-d/ (Retrieved May 2022).