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Hepatitis D infection may be diagnosed by detecting the antibody against the virus. Measuring antibodies to delta antigen using enzyme-linked immunosorbent assay (ELISA) can make the diagnosis. Immunoglobulin M (IgM) antibodies are increased when there is liver damage and not just in the acute illness and appear to disappear when there is resolution of the hepatitis. HDV-Ag is detectable in the nuclei and to a lesser extent in the cytoplasm of infected cells and serum, as is HDV-RNA, detected by molecular hybridization.

Antibody against HDV usually is found no sooner than 30 days after symptoms appear. Until recently, the virus itself could only be identified by testing a small sample of liver tissue. Scientists now are developing a blood test for HDV that should make diagnosis faster and easier. When HDV is present, liver enzymes (proteins made by the liver) are present in abnormally high amounts. In some patients with coinfection, the enzyme levels peak twice, once when HBV infection starts and again at the time of HDV infection.

Exams and Tests

1.Liver enzymes
2.Liver biopsy
3.Anti-delta agent antibody

The doctor who will diagnose the patient will go through the medical history of the patient. He or she will give emphasis on the patient’s alcohol consumption, medications, previous surgeries as well as sexual activity. The doctor will also check the tenderness or enlargement of the liver. There are different types of lab tests which the doctors will ask the patients to do. Some of these include blood tests and liver panel tests. Other tests include ELISA II, RIBA II. The doctor can also ask you to go through a liver biopsy. In this case a small portion of the liver will be taken for further examination under the microscope.

Hepatitis D virus (HDV) is a small defective virus with a single stranded circular RNA of 1.7 kb in size.1-3 Its hepatitis B surface antigen (HBsAg) envelope is provided by the helper hepatitis B virus (HBV) for successful package and transmission of HDV.4,5 The antigenomic strand of HDV encodes a single protein, hepatitis delta antigen (HDAg) of two molecular weight forms. The large form HDAg with a 19-amino acid extension at the C-terminus plays a key role in the package of HDV and suppresses viral replication in a trans-dominant negative manner, while the small form plays an essential role in trans-activating the replication of HDV RNA.

Diagnostic Tests Serum enzymes (aspartate aminotransferase [serum glutamic oxaloacetic transaminase], alanine aminotransferase [serum glutamic pyruvic transaminase]) 8 to 20 times normal values during the prodromal and clinical phases, lactate dehydrogenase is 1 to 3 times normal. These elevations are the hallmark of the disease. The differential diagnosis is based on the clinical history and various laboratory tests. In HAV, the stool is positive for the virus 2 to 4 weeks after exposure, and the enzyme-linked immunosorbent assay (ELISA) shows a rise in HAV antibodies. In HBV, serum antigen tests detect HBAg, and serum antibody tests detect a rise in anti-HBe. A serum test for HCV is now available.