A known HBsAg-positive man with previously normal ALT develops acute icteric hepatitis with ALT of 1200 IU/mL. Anti-HDV IgM is positive and HBV DNA is low. Compared with simultaneous acquisition of both viruses, his outcome carries a higher risk of:
- A Fulminant hepatitis and progression to chronic HDV infection ✓
- B Asymptomatic seroconversion with clearance of both viruses
- C Complete recovery with lifelong immunity to hepatitis D
- D Reactivation of hepatitis A acquired concurrently
Correct answer: A. Fulminant hepatitis and progression to chronic HDV infection
Explanation
This is HDV superinfection of a chronic HBsAg carrier. Superinfection produces severe acute disease with a high risk of fulminant hepatitis and, in up to 80 to 90 percent of cases, progression to chronic dual infection with accelerated cirrhosis. In contrast, HDV-HBV co-infection usually resolves completely because the acute HBV infection is cleared, removing the helper HBsAg needed by the defective HDV. Reactivation of hepatitis B is not a recognized entity.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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