Higher mortality rates are associated with chronic hepatitis B carriers when coinfected with which virus?

• A. Hepatitis D
• B. Hepatitis A
• C. Hepatitis C
• D. HIV

Answer: (A)

Higher mortality in chronic hepatitis B carriers occurs with hepatitis D coinfection. HDV is a defective RNA virus that cannot replicate on its own and relies on HBV’s surface antigen to assemble. When someone with chronic HBV acquires HDV (either as a concurrent infection or superinfection), the liver injury tends to be more severe, progression to cirrhosis occurs more rapidly, and there is a higher risk of fulminant hepatitis and death compared with HBV alone. Vaccination against HBV also helps prevent HDV infection, since HDV needs HBV to propagate. While hepatitis A, C, or HIV coinfections can complicate disease, the strongest link to increased mortality in chronic HBV carriers is HDV coinfection.