How does the hepatitis D virus destroy the liver?

Hepatitis D virus (HDV) cannot exist and replicate alone. Instead, HDV needs to borrow the outer shell of hepatitis B virus (HBV) to enter and cause damage to liver cells. MSc. Doan Bich Hang, Department of Gastroenterology – Hepatobiliary – Pancreas, Tam Anh General Hospital, Hanoi, said the risk of liver disease progression in the group of patients co-infected with HDV-HBV is higher than the group infected with HBV alone.

When HDV invades liver cells, the immune system is strongly activated to control the virus. However, this excessive immune response simultaneously attacks liver cells, causing widespread necrosis. Some cases can lead to acute inflammation and acute liver failure on top of a damaged liver. Inflammation that lasts long or recurs many times can easily turn into a chronic stage.

Repeated or prolonged damage caused by the hepatitis D virus prevents liver cells from recovering in time. As a result, liver cells are destroyed quickly and on a large scale. Prolonged inflammation also causes healthy liver tissue to quickly be replaced by fibrotic tissue, the liver gradually loses its ability to regenerate, leading to a decline in vital functions such as detoxification, protein synthesis and metabolic regulation.

HDV-HBV co-infection causes serious liver damage, easily causing complications such as ascites, gastrointestinal bleeding, peritoneal fluid infection or hepatic encephalopathy. Some patients may also have acute liver failure on top of chronic hepatitis, which is life-threatening.

According to Dr. Hang, hepatitis D virus also significantly increases the risk of hepatocellular carcinoma. Prolonged chronic inflammation along with continuous damage and regeneration of liver cells creates a favorable environment for cells to change, promoting the formation of malignant cells.

In the early stages, hepatitis D virus symptoms are not typical such as fatigue, loss of appetite, a feeling of heaviness in the right lower quadrant… Liver enzymes may increase but fluctuate erratically. In people with chronic hepatitis B, these signs are easily confused with outbreaks of chronic hepatitis B virus, making diagnosis difficult.

Dr. Hang recommends that people with hepatitis B should be periodically monitored, tested for liver function and screened for co-infected viruses. Early detection of HDV and timely intervention can help improve liver disease. People who have not been infected with hepatitis B virus can get the hepatitis B vaccine to prevent the risk of getting the disease.