Hepatitis D can only occur in patients who are simultaneously (coinfection) or previously (superinfection) infected with HBV. Common symptoms of hepatitis D include: fever; yellowish discoloration of the eyes and skin; fatigue; abdominal pain; loss of appetite; nausea; vomiting; and dark urine. Coinfection is associated with a more severe form of the disease, often leading to fulminant hepatitis. In superinfection, symptoms may be unspecific initially, and the majority of these cases progress into chronicity.^[1][2]

Part of the initial evaluation for HDV infection includes a thorough patient history focusing on potential modes and timing of infection. Aspects covered in the patient’s history include:^[3]

• Exposure to blood and/or blood products
• Injection drug use(IDU)
• Sexual exposure
• Occupational exposure
• Recent history of invasive procedures performed in non-hospital health care settings, including hemodialysis centers and long-term care facilities^[4]

In chronic HDV, history taking includes obtaining information regarding factors associated with the progression of liver disease.^[5] The following aspects should be covered:^[5][3]

• Risk factors for coinfection with HDV, HCV, and HIV
• Family history of liver disease and HCC
• Medication history
• Smoking status
• Alcohol consumption
• Drug abuse
• Sexual activity
• Antiretroviral drug regimen if coinfected with HIV(to assess potential for treatment resistance)

Symptoms of hepatitis D are similar to those of hepatitis B. Simultaneous infection with HBV and HDV (coinfection) often courses with a severe acute form of the disease, usually with ab abrupt onset of symptoms.^[1]

Simultaneous infection with HDV and HBV (coinfection) is associated with a more severe form of the disease, often leading to fulminant hepatitis. In the case of infection with HDV, in a previously HBsAg positive patient (superinfection), symptoms may be unspecific initially. In this last case, the disease often tends to chronicity. Common symptoms of both forms of the disease include:^[1][2]

• Fever
• Yellowish discoloration of the eyes and skin
• Fatigue
• Abdominal pain
• Loss of appetite
• Nausea
• Vomiting
• Joint pain
• Muscle pain
• Dark (tea colored) urine
• Clay-colored stools
• Skin rash