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Hepatitis D: the infection that makes hepatitis B worse | CION Cancer Clinics
Hepatitis D is a virus that can only infect someone who already has hepatitis B. Together, the two viruses usually scar the liver faster and raise the risk of liver cancer more than hepatitis B alone. This page explains how hepatitis D spreads, why it is often missed, which blood tests find it, what treatment exists in India, and why the hepatitis B vaccine protects against both. At CION Cancer Clinics, our specialists help you understand your own risk and plan regular liver checks that fit it.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
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On this page
- What is hepatitis D, and why does it matter with hepatitis B?
- Coinfection or superinfection: what is the difference?
- How is hepatitis D tested, and who should ask?
- Can hepatitis D be treated in India?
- Four things people assume about hepatitis D
- What this page cannot tell you
- Common questions about hepatitis D
The short answer
What is hepatitis D, and why does it matter with hepatitis B?
Hepatitis D, also called hepatitis delta, is a virus that can only live in someone who already has hepatitis B. On its own it cannot infect anyone. Together with hepatitis B, it usually damages the liver faster, leads to cirrhosis sooner and raises the risk of liver cancer above hepatitis B alone.
A virus that borrows from another
The hepatitis D virus is incomplete. It needs the outer coat of the hepatitis B virus to make copies of itself. That is why it is only ever found in people who test positive for HBsAg, the hepatitis B surface marker. It also means anything that protects against hepatitis B protects against hepatitis D as well.
Why it is easy to miss
Hepatitis D is not part of most routine hepatitis B check-ups in India. Someone can be told they are a hepatitis B carrier for years without anyone checking for delta. It is often found only when the liver is doing worse than the hepatitis B results would explain.
This page is about the virus as a cause of liver damage and liver cancer. It does not tell you whether a liver lesion you have been told about is cancer.How people get it
Coinfection or superinfection: what is the difference?
Doctors use two words for hepatitis D, depending on when it arrived. The difference changes what usually happens next.
Coinfection
Hepatitis B and D arrive at the same time, from the same exposure. The first illness can be severe, but most adults then clear both viruses, as they would clear hepatitis B alone.
Superinfection
Hepatitis D arrives in someone who already carries hepatitis B. This is the pattern that tends to become long-term, and it is the one linked to faster scarring and cancer.
Often looks like
- A known carrier whose liver tests suddenly worsen
- Cirrhosis at a younger age than expected
- Low hepatitis B viral load but ongoing liver damage
How it spreads
Through blood, much as hepatitis B does: shared needles or syringes, unscreened blood, unsterile instruments and, less often, sex. Passing from mother to baby is uncommon. It is not spread through food, water or sharing a plate.
Why the risk adds up
Two viruses inflame the liver more than one. Years of extra inflammation build more scar tissue. Scarred liver is where most liver cancer grows, so the cancer risk rises with it.
Not sure whether this applies to you?
Ask an oncologistGetting checked
How is hepatitis D tested, and who should ask?
Confirm hepatitis B first
Only people with a positive HBsAg need the test. If you are not sure of your hepatitis B status, the hepatitis B report page explains what each marker means.
The antibody test
A blood test for anti-HDV shows whether you have ever met the delta virus. Many guidelines now suggest everyone with hepatitis B is checked at least once.
The virus test
If the antibody is positive, an HDV RNA test shows whether the virus is active now. This test is available at fewer laboratories, and samples may be sent out.
Measure the liver
Liver blood tests, an ultrasound and often elastography (FibroScan, a scan that measures stiffness) show how much scarring is present. CION arranges these through its diagnostic partners.
Treatment, honestly
Can hepatitis D be treated in India?
- Hepatitis B tablets
- Entecavir and tenofovir control hepatitis B but do not act on the delta virus directly. They may still be needed for the hepatitis B part.
- Pegylated interferon
- An injection that has been used for hepatitis D for many years. It helps only some people, has real side effects and is not safe to use in advanced cirrhosis.
- Bulevirtide
- A newer medicine that blocks the virus from entering liver cells. It is approved in Europe. As of 2026 it is not approved in India and is not routinely available here.
- Who decides
- Hepatitis D treatment belongs to a hepatologist. CION coordinates that care with partner hepatologists when cancer care is also involved.
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Commonly believed
Four things people assume about hepatitis D
"My hepatitis B viral load is low, so my liver is safe."
Hepatitis D often keeps the hepatitis B count low while it does damage of its own. A low hepatitis B number with worsening liver tests is one reason doctors check for delta.
"Hepatitis D means someone did something wrong."
People pick it up through hospital procedures, old blood transfusions and family exposures as well as injecting. How a person got it changes nothing about the care they deserve.
"There is a separate vaccine I need for hepatitis D."
There is no separate vaccine. The hepatitis B vaccine prevents hepatitis D as well, because delta cannot infect anyone without hepatitis B. Vaccinating the household is the best protection.
"If I already have both, scans are pointless."
The opposite is true. People with both viruses are exactly the group in which regular liver cancer surveillance finds tumours small, when more treatment choices are open.
Being straight with you
What this page cannot tell you
It cannot tell you whether you have hepatitis D, how fast your liver is changing, or what your own cancer risk is. Those answers come from blood tests, a stiffness scan and a hepatologist who has seen your whole history. Evidence on hepatitis D in India is also thinner than for hepatitis B, and how common it is varies from region to region.
What it means for surveillance
If you carry hepatitis D, ask your doctor how often you should have liver ultrasound and AFP blood tests. Many people with both viruses are advised to have them regularly even before cirrhosis is confirmed. The surveillance for hepatitis B carriers page explains how that schedule is usually set.
Who this does not apply to
If your HBsAg is negative, hepatitis D is not a risk for you, and this page does not apply. If you have hepatitis B and C together rather than B and D, the hepatitis B and C page is the closer match.
If you have hepatitis B and have never been tested for delta, ask at your next liver check-up.Questions we are asked
Common questions about hepatitis D
Can I get hepatitis D without hepatitis B?
No. The delta virus needs the hepatitis B virus to make copies of itself. Someone with no hepatitis B, or who is fully protected by the hepatitis B vaccine, cannot carry hepatitis D. That is why the test is only offered to people who are HBsAg positive.
Does hepatitis D always lead to liver cancer?
No. It raises the risk, mainly by speeding up scarring, but many people with both viruses never develop cancer. What it does change is how closely the liver should be watched, so that anything new is found early.
What does a positive anti-HDV result mean?
It means you have met the delta virus at some point. It does not show whether the virus is active today. An HDV RNA test answers that question, and your doctor will usually arrange it next before deciding anything about treatment.
Can hepatitis D be removed from the body?
In some people interferon treatment clears the delta virus, but many do not respond, and relapse can happen. Newer medicines are being studied abroad. For most people today, the aim is to slow the liver damage and to watch carefully for cancer.
Should my family be tested?
Household members should be tested for hepatitis B first. Anyone not protected should be vaccinated, which also protects them from delta. Relatives who already have hepatitis B can ask their own doctor about a hepatitis D test. The family testing page explains how to start.
Does hepatitis D change liver cancer treatment?
The cancer treatment itself is planned on the tumour, the liver function and your fitness. Hepatitis D usually means more scarring, which can narrow the choices. The tumour board considers the liver as carefully as the tumour when the plan is made.
Is the HDV RNA test available in Hyderabad?
Some laboratories offer it, and others send samples to a reference laboratory. Availability and turnaround vary. Ask your doctor where the test will be done, and keep a copy of the report with your other hepatitis results.
Who should I speak to first?
A hepatologist or physician manages hepatitis D. If a scan has shown something in the liver, or you already have liver cancer, call the CION helpline. The team can arrange a consultation and coordinate with a hepatologist so both are looked after together.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- MedlinePlus — Hepatitis
- NHS — Hepatitis
- NIDDK — Hepatitis B - NIDDK
- NHS — Causes of liver cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
How hepatitis B causes liver cancerThe underlying pathway hepatitis D speeds upSurveillance for hepatitis B carriers without cirrhosisHow often the liver should be checkedHepatitis B vaccination is cancer preventionThe one vaccine that also prevents hepatitis DHepatitis B and C togetherIf your second virus is C rather than D
Talk to us
Have hepatitis B and never been checked for hepatitis D?
Share your hepatitis reports and any recent scans with us. We can arrange the right tests and coordinate with a hepatologist so your liver and your cancer risk are looked at together. One helpline serves every CION centre.