P2878 - Hepatitis D Infection in High-Risk Patients

Andrew Alabd, MD¹, Daniel A. Ricketti, MD, MBA¹, Krysta Contino, MD^2
1Cooper University Hospital, Camden, NJ; ²Cooper Digestive Health Institute, Camden, NJ

Introduction: Hepatitis D virus (HDV) infection is dependent on the presence of hepatitis B virus (HBV). Diagnosis requires abnormal liver chemistries, history of exposure, and consideration of modes of transmission followed by directed laboratory testing. We report a case of viral hepatitis in a high-risk patient to highlight HDV testing and the appropriate serology to differentiate HDV superinfection from HBV/HDV coinfection.

Case Description/Methods: A 34-year-old woman with a history of intravenous (IV) drug use presented with a month of abdominal pain, diarrhea, and non-bloody and non-bilious emesis after presentation to another hospital approximately six weeks prior, where she was diagnosed with acute hepatitis B [positive Hepatitis B Surface Antigen (HBsAg,) positive anti-HBV core IgM), prior exposure to Hepatitis C (positive hepatitis C antibody)] and left against medical advice (AMA). An examination revealed scleral icterus; the abdomen was tender, soft, and nondistended, with normal bowel sounds and no stigmata of chronic liver disease. Liver chemistries were notable for alkaline phosphatase (ALP) 367 U/L, total bilirubin (TB) 7.2 mg/dL, direct bilirubin (DB) 5.4 mg/dL, alanine aminotransferase (ALT) 607 U/L, aspartate aminotransferase (AST) 695 U/L, INR 1.2, and MELD-Na 18. Viral hepatitis tests were positive for HBsAg, HDV PCR, and an HBV DNA of 7,500,000 IU/ml but negative for anti-HBV core IgM. She left AMA and presented a week later with worsening symptoms and rising liver chemistries. She was started on tenofovir alafenamide and showed significant improvement in liver chemistries (Figure 1), but did not adhere to outpatient follow-up. Six months later, HBsAg was no longer detectable with negative anti-HBs, but the test for anti-HBc was positive, with further testing showing positive-IgM anti-HAV; liver chemistries were again significantly elevated. She again left AMA.

Discussion: HDV requires the presence of HBV for complete virion secretion and infection; however, the geographic distribution of HDV infection does not parallel that of HBV. HDV is uncommon in the US, but prevalent in high-risk groups (e.g., IV drug users). The presence of HBsAg is necessary to diagnose HDV. The additional presence of anti-HBV core IgM is necessary to diagnose acute HBV/HDV coinfection. HDV infection can lead to acute liver failure, which necessitates screening in high-risk patients with HBV infection. Vaccination against Hepatitis A is essential if patients are not immune.



Disclosures:


Andrew Alabd, MD¹, Daniel A. Ricketti, MD, MBA¹, Krysta Contino, MD². P2878 - Hepatitis D Infection in High-Risk Patients, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.