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HDV is a defective RNA virus that requires the presence of Hepatitis B virus to replicate and cause infection Written by Adithi PH With quotes from Dr Shiran Shetty (gastroenterologist), Dr Chetan Kalal (hepatologist). HDV can only infect individuals who are already infected with HBV, either through simultaneous co-infection or subsequent superinfection. Hepatitis D Virus (HDV), also known as the Hepatitis Delta Virus, is a unique and serious pathogen that leads to the most severe form of viral hepatitis. Unlike other hepatitis viruses, HDV requires co-infection with the Hepatitis B Virus (HBV) to replicate and infect, resulting in chain of liver complications beginning with liver inflammation, fibrosis (scarring of the liver), which can further result in cirrhosis (severe scarring) and hepatocellular carcinoma (HCC), a type of liver cancer. A 2020 study published in The Lancet Global Health assessed the global prevalence of Hepatitis D. It involved analysing data from over 120,000 individuals across various geographical regions.  The results showed that HDV affects an estimated 12 million people globally. This shows the need for improved surveillance and prevention strategies for HDV due to the high risk of its progression to liver cirrhosis and liver cancer. The study says that globally, among the general population the prevalence of HDV is 0.16 %. However, WHO data, mentions that Hepatitis D virus (HDV) affects globally nearly 5% of people who have a chronic infection with hepatitis B virus (HBV). Structural differences between HDV and other hepatitis viruses Dr Shiran Shetty, professor, department of gastroenterology and deputy medical superintendent, Kasturba Hospital, Manipal explains that HDV is distinct from other hepatitis viruses like Hepatitis A, B, C, and E, in its structure and infection process. “Unlike other hepatitis viruses that have their protein coats, HDV is a defective virus that cannot replicate independently. HDV cannot replicate on its own and requires the presence of the hepatitis B virus (HBV) to replicate and cause infection. HBV is a DNA virus that infects the liver,” he said. When it comes to genetic structure, the genome of HDV is a single-stranded circular RNA molecule whereas other hepatitis viruses have different genomic structures. “Hepatitis D virus (HDV) is a defective virus that unlike other hepatitis viruses, does not have its own envelope protein; instead, it utilizes HBV’s envelope proteins for its assembly and secretion,” says Dr Chetan Kalal, Program Director of Liver, Pancreas, and Intestine Transplantation, Nanavati Max Super Specialty Hospital, Mumbai. HDV can only infect individuals who are already infected with HBV, either through simultaneous co-infection or subsequent superinfection. Dr Shetty explains, “co-infections occur when both viruses are acquired at the same time, while superinfection occurs when someone who is already chronically infected with HBV acquires HDV.” In both cases, the severity of liver disease is typically worse than with HBV alone. HDV’s reliance on HBV means it cannot infect or replicate in people who are not infected with HBV. Primary Modes of Transmission In rare cases a person may get infected with HDV even in the absence of HBV infection. Experts explain that the HDV can be transmitted from an HDV infected person to others through means of sexual contact, injection drug use (sharing needles and syringes contaminated with the blood of an HDV-infected person), transmission from mother to child during childbirth, and exposure to contaminated blood or blood products. Dr Kalal adds that people who are already infected with HBV can acquire HDV through exposure to contaminated blood or bodily fluids. Symptoms and disease progression The symptoms of HDV include fatigue, jaundice, abdominal pain, nausea, and joint pain, but experts add that disease progression patterns depend on whether the person is co-infected or superinfected, and the presence of other liver conditions. “HDV can lead to acute hepatitis, fulminant hepatitis, cirrhosis, and liver cancer,” says Dr Shetty. In co-infections, acute hepatitis may resolve without significant complications, but in superinfections, there is a higher risk of progression to chronic liver disease and cirrhosis. “Chronic HDV infection increases the risk of developing cirrhosis, liver decompensation, and hepatocellular carcinoma compared to chronic HBV infection alone,” adds Dr Kalal. Managing and treating HDV “HDV’s dependence on HBV makes it challenging to treat and control as the treatment options for HDV infection are limited,” says Dr Shetty. He adds that while currently there are no approved specific antiviral therapies for HDV infection, management strategies focus on controlling HBV replication, preventing liver damage, and managing complications associated with HDV infection. Some of the recommended treatment options and management strategies according to experts are: Interferon-based therapy: Interferons are lab made proteins used in the treatment against HDV. It is the only treatment with proven efficacy against HDV, but response rates vary among individuals. HBV antiviral therapy: Since HDV requires HBV for its replication, treatment of the latter may indirectly suppress the HDV replication by reducing HBV DNA levels. Liver transplantation: This option may be considered for people with end-stage liver disease. However, HDV can recur in the transplanted liver, and outcomes may be less favorable compared to liver transplantation for other indications. Hepatitis delta virus: Precautions to take Dr Shetty explains that preventing HDV transmission involves similar strategies to those used for preventing other bloodborne infections, like safe injection practices, using contraceptive barriers during sexual intercourse, screening blood and blood products for HDV, and promoting HBV vaccination to prevent HBV infection, which can subsequently prevent HDV infection. However, there is no vaccine against HDV. “Screening high-risk populations, such as individuals with HBV infection or injection drug users, for HDV infection is crucial for early detection and management,” adds Dr Kalal. Takeaways Hepatitis Delta Virus relies on the envelope proteins of Hepatitis B virus to replicate and infect. Transmission occurs mainly through direct exposure to blood or bodily fluids containing the virus. The disease can vary from asymptomatic to severe hepatitis, often progressing rapidly to chronic liver disease. Preventive measures such as HBV vaccination, safe injection practices, and high-risk population screening are crucial. There is no vaccine against HDV. Interferon-based therapy, HBV antiviral therapy, and liver transplantation are some treatment options for HDV.

Cirrhosis isn’t just a fancy word for liver troubles— it’s a serious condition caused by years of damage, often from chronic alcohol abuse or hepatitis. If you’re feeling unusually tired, seeing yellow around the edges (hello, jaundice), or dealing with unexplained bloating, your liver might be sending you a distress signal. Get the lowdown on cirrhosis, and find out how to keep your liver happy by controlling your alcohol intake, getting vaccinated, and sticking to a healthy diet. It’s your liver’s turn for a break! #Cirrhosis #LiverDisease #LiverCare #HealthyLiving #LiverHealthAwareness #LiverWellness #PreventCirrhosis #CirrhosisPrevention

Rajkumar Hirani, celebrated Indian Filmmaker & Mr Abhijat Joshi, Indian screenwriter, film director, producer and editor graced the event as chief guests. On the backdrop of World Liver Day, Nanavati Max Super Speciality Hospital organized a ‘Walk-a-thon,’ to celebrate the remarkable success stories of Liver donors and recipients. The event demonstrated the vitality and normalcy achievable post-liver transplant for both donors and recipients, drawing over 120 healthy donors, recipients and senior members of the community. Mr Rajkumar Hirani, a celebrated Indian Filmmaker and National Film Awardee and Mr Abhijat Joshi, Indian screenwriter, film director, producer and editor graced the event as chief guests. The eminent duo inaugurated the advanced Fibroscan Department of Nanavati Max Hospital alongside Dr Chetan Kalal, Program Director – Hepatology & Transplant Medicine, Dr Anurag Shrimal, Director, Transplant Surgery, Dr Anil Singh, Director – Liver Transplant, Anaesthesia and Critical Care, Dr Vibhor Borkar, Director – Paediatric Hepatology & Gastroenterology & Dr Deepak Patkar, Director – Medical Services. The participants warmed up with a lively Zumba session led by the hospital’s expert physiotherapy team, followed by the official flag off of the Walk-a-thon by the eminent duo; Mr. Rajkumar Hirani and Mr. Abhijat Joshi. Radio personality RJ Sudarshan, from RadioCity 91.1, kept the crowd energized with engaging commentary and health tips throughout the event. Actress Aditi Gautam, known for her roles in ‘Neninthe’ (Telugu) and ‘Sanju,’ (Hindi) graced the donor felicitation ceremony and honored the courageous group of organ donors alongside the doctors of Nanavati Max Institute of Liver, Pancreas and Intestine Transplantation. Speaking on the occasion, Dr Kalal said, “early detection and proactive liver screening are key steps to prevent serious health concerns and ensure long-term wellbeing. We encourage everyone to understand the importance of timely diagnosis and how it can significantly improve the effectiveness of treatment. Let’s prioritize our liver health today for a healthier tomorrow.“

On the backdrop of World Liver Day, Nanavati Max Super Speciality Hospital organized a ‘Walk-a-thon,’ to celebrate the remarkable success stories of Liver donors and recipients. The event demonstrated the vitality and normalcy achievable post-liver transplant for both donors and recipients, drawing over 120 healthy donors, recipients and senior members of the community. Rajkumar Hirani, a celebrated Indian Filmmaker and National Film Awardee and Mr Abhijat Joshi, Indian screenwriter, film director, producer and editor graced the event as chief guests. The eminent duo inaugurated the advanced Fibroscan Department of Nanavati Max Hospital alongside Dr Chetan Kalal, Program Director – Hepatology & Transplant Medicine, Dr Anurag Shrimal, Director, Transplant Surgery, Dr Anil Singh, Director – Liver Transplant, Anaesthesia and Critical Care, Dr Vibhor Borkar, Director – Paediatric Hepatology & Gastroenterology & Dr Deepak Patkar, Director – Medical Services. The participants warmed up with a lively Zumba session led by the hospital’s expert physiotherapy team, followed by the official flag off of the Walk-a-thon by the duo; Rajkumar Hirani and Abhijat Joshi. Radio personality RJ Sudarshan, from RadioCity 91.1, kept the crowd energized with engaging commentary and health tips throughout the event. Actress Aditi Gautam, known for her roles in ‘Neninthe’ (Telugu) and ‘Sanju,’ (Hindi) graced the donor felicitation ceremony and honored the courageous group of organ donors alongside the doctors of Nanavati Max Institute of Liver, Pancreas and Intestine Transplantation. Dr Kalal said, “early detection and proactive liver screening are key steps to prevent serious health concerns and ensure long-term wellbeing. We encourage everyone to understand the importance of timely diagnosis and how it can significantly improve the effectiveness of treatment. Let’s prioritize our liver health today for a healthier tomorrow.”

As we approach April 19th, 2024, we prepare to observe World Liver Day—a day dedicated to raising awareness about liver health and the importance of preventive measures against liver diseases. The liver, often referred to as the body’s powerhouse, is a vital organ responsible for a myriad of functions essential for our well-being. Yet, despite its significance, liver diseases continue to pose a significant global health burden. This World Liver Day, let us delve into the importance of liver health and the steps we can take to protect this remarkable organ. Understanding the Significance of Liver Health: The liver is a multitasking marvel, playing a crucial role in digestion, metabolism, detoxification, and immune function. From filtering toxins and metabolizing nutrients to producing proteins and bile, the liver performs an array of vital functions that are indispensable for maintaining our health. However, various factors such as unhealthy diet choices, excessive alcohol consumption, viral infections, obesity, and genetic predispositions can jeopardize liver health, leading to the development of liver diseases. Shining a Light on Common Liver Diseases: Liver diseases come in various forms, each with its own set of causes, symptoms, and consequences. Hepatitis, liver cirrhosis, non-alcoholic fatty liver disease (NAFLD), and liver cancer are among the most prevalent liver conditions worldwide. Hepatitis, caused by hepatitis viruses, can lead to liver inflammation and, if left untreated, progress to liver cirrhosis and cancer. NAFLD, often associated with obesity and metabolic syndrome, is a leading cause of liver dysfunction in Western countries. Liver cancer, particularly hepatocellular carcinoma, typically arises in individuals with underlying liver diseases such as cirrhosis or chronic hepatitis B or C infection. Empowering Prevention and Treatment: While liver diseases can be formidable adversaries, preventive measures and early interventions can mitigate their impact. Adopting a healthy lifestyle, maintaining a balanced diet, limiting alcohol consumption, staying physically active, and avoiding risky behaviors such as injection drug use are key strategies for safeguarding liver health. Additionally, vaccination against hepatitis B, screening for hepatitis C, and timely medical interventions can help prevent the progression of liver diseases and improve outcomes for affected individuals. Raising Awareness and Taking Action: On World Liver Day 2024, let us renew our commitment to promoting liver health awareness and fostering initiatives aimed at preventing and managing liver diseases. Through education, advocacy, and community engagement, we can empower individuals to make informed choices about their liver health and access the necessary resources and support services. By prioritizing liver health on a global scale, we can work towards a future where liver diseases are less prevalent, better understood, and effectively controlled. Conclusion: As we commemorate World Liver Day 2024, let us recognize the significance of liver health in maintaining overall well-being and pledge to take proactive steps to protect this vital organ. By embracing healthy lifestyle habits, advocating for liver health initiatives, and supporting individuals affected by liver diseases, we can make a tangible difference in reducing the burden of liver-related illnesses worldwide. Together, let us strive towards a world where everyone has the opportunity to live a healthy and fulfilling life, free from the threat of liver diseases.

I had the honor and privilege of being present at the prestigious book launch event for “Own Your Body” by none other than my esteemed mentor, Dr. Shiv Sarin. The anticipation and excitement were palpable as attendees eagerly awaited the unveiling of this highly anticipated literary masterpiece. As the event unfolded, I found myself immersed in an atmosphere of intellectual discourse and profound insight into the intricacies of human health and wellness. Dr. Shiv Sarin, a luminary in the field of medicine and a beacon of knowledge, presented his latest work with eloquence and passion. “Own Your Body” is not just a book; it’s a manifesto for taking charge of one’s health and well-being. Through meticulous research and years of clinical experience, Dr. Sarin has crafted a comprehensive guide that empowers readers to understand and embrace the complexities of their own bodies. The highlight of the evening was undoubtedly the opportunity to receive a signed copy of “Own Your Body” from Dr. Sarin himself. Holding the book in my hands, I couldn’t help but feel a sense of gratitude for the invaluable mentorship and guidance that he has provided me over the years. This signed copy is not just a keepsake; it’s a symbol of the profound impact that Dr. Sarin has had on my personal and professional journey. In addition to Dr. Sarin’s enlightening presentation, the event was graced by the presence of several prominent personalities from the world of entertainment and literature. Mr. Anil Kapoor, a legendary actor known for his versatility and charisma, lent his support to the book launch, alongside his daughter, the talented actress Sonam Kapoor. Renowned filmmaker Raju Hirani and acclaimed screenwriter Abhijat Joshi also added to the star-studded lineup, further elevating the significance of the occasion. As I reflect on the memorable evening spent at the book launch event for “Own Your Body,” I am reminded of the profound impact that literature can have on our lives. Dr. Shiv Sarin’s book is not just a literary work; it’s a beacon of knowledge and inspiration that has the power to transform lives. I eagerly anticipate delving into its pages and embarking on a journey of self-discovery and empowerment. #BookLaunch #OwnYourBody #DrShivSarin #Mentorship #Gratitude #HealthAndWellness #Inspiration #AnilKapoor #SonamKapoor #RajuHirani #AbhijatJoshi #Literature #Empowerment #TransformativeReading

In Short Skipping breakfast can be deadly in the long run Studies shows that every ‘1 in 4 urban Indian’ claim to skip breakfast A healthy Breakfast not only kick-starts the metabolic processes but supports overall health “I was in a hurry.” “It’s okay, I will have lunch directly.” “I had a fruit.” “I had a heavy dinner.” These are some of the excuses that we tell ourselves when we skip breakfast. However, often, skipping breakfast, which initially starts due to time constraints or just pure laziness, soon turns into a habit (not a good one, btw). This habit of skipping breakfast not only leads to heart problems, but can also be deadly in the long run. The most skipped meal: Breakfast We Indians, are, of course, known for their good food. However, when it comes to breakfast, we often tend to skip it, thinking we can compensate for it with a fruit, a cup of coffee or, even worse, at lunch. There are a few studies on breakfast patterns in India, and the number does not look good. For instance: A study by Kellogg’s states that every ‘1 in 4 urban Indians’ claims to skip breakfast, and it was seen across all age groups. The study also found that around 72% skimp by having a nutritionally inadequate breakfast meal. Most important meal of the day? Suvarna Sawant, chief dietician at Nanavati Max Super Speciality Hospital in Mumbai, shares that as a nutritionist, she always stresses the significance of a nutritious breakfast. Eating breakfast kickstarts your metabolism, helping your body burn calories throughout the day. Photo: Getty Images “Being the most important meal of the day, breakfast induces metabolism and improves gut health,” she says. Now, there are various reasons why breakfast is considered as an important meal of the day. Kickstarts metabolism Eating breakfast kickstarts your metabolism, helping your body burn calories throughout the day. This can aid in weight management and energy levels. Fuel for the brain After a night of fasting, breakfast provides essential nutrients and energy to the brain, improving concentration, focus, and cognitive function. Maintains nutrient intake A nutritious breakfast can provide vital nutrients such as vitamins, minerals, protein, and fibre, which are important for overall health and well-being. Regulates blood sugar Eating breakfast helps stabilise our blood sugar levels, preventing spikes and crashes that can lead to cravings and overeating later in the day. Prevents overeating Starting the day with a balanced meal can help control hunger and prevent overeating at subsequent meals, promoting better portion control and weight management. “A regular healthy breakfast also helps in weight management, especially in urban areas, where sedentary lifestyles and consumption of processed foods is high,” says Suvarna. What skipping breakfast does Suvarna says skipping breakfast can lead to low energy levels and causes a lack of essential nutrients, affecting our productivity and well-being. “For individuals involved in physically demanding activities, missing a breakfast can result in undernutrition and compromise the ability to perform labour-intensive tasks,” she adds. Ruins your digestive health Dr Chetan Kalal, program director of Nanavati Max Institute of Gastroenterology, Hepatology & Therapeutic Endoscopy, Mumbai, explains that as a gastroenterologist, he always emphasises the importance of breakfast for maintaining gastrointestinal health. Skipping breakfast can disrupt the release of digestive enzymes. Photo: Getty Images “Missing this important meal of the day can harm the digestive system,” he says. How? Dr Kalan explains that if we skip our breakfast, it can cause a disruption in the release of digestive enzymes and lead to disruption of the circadian rhythm of the digestive tract. This can lead to issues such as: Indigestion Bloating Altered bowel habits According to him, it can also potentially contribute to the development of gastroesophageal reflux disease (a chronic, usually lifelong disease that develops in your gut) and other functional gastrointestinal disorders. Impact your heart We know that heart-related diseases are on the rise. But do heart-related problems have a connection with skipping breakfast? Apparently, yes. Dr Vivudh Pratap Singh, senior consultant, interventional cardiology, Fortis Escorts Heart Institute, Okhla Road, New Delhi, explains that skipping breakfast occasionally might not necessarily lead directly to heart-related issues, but consistently skipping breakfast over time “could potentially contribute to certain risk factors associated with heart health”. He refers to a 2019 study that suggests regularly skipping breakfast may be linked to an increased risk of developing conditions such as obesity, high blood pressure, high cholesterol levels, and Type 2 diabetes, all of which are risk factors for heart disease. “Skipping breakfast could affect insulin sensitivity and glucose metabolism, which are also factors in heart health,” he says. Consistently skipping breakfast over time could potentially contribute to certain risk factors associated with heart health. Photo: Getty Images However, please also remember that skipping breakfast may contribute to certain risk factors for your heart, but it’s not the sole reason for heart-related issues. Cause weight gain Since the beginning of time, we’ve been told that eating less can lead to weight loss. But here’s the deal, skipping breakfast will not make you skinny, rather it may contribute to your weight gain. Here’s why: Regularly skipping breakfast can lead to overeating throughout the day, as we may compensate by grazing or consuming larger portions later on. This behaviour can increase hunger and prompt choices of foods high in fats and carbohydrates, which may seem more filling. Moreover, skipping breakfast can disrupt blood sugar levels, potentially complicating the body’s ability to metabolise food and contributing to obesity. Various research, including a study published in The American Journal of Clinical Nutrition, says eating breakfast can lead to the benefits of eating breakfast daily, such as reducing dietary fat intake and curbing impulsive snacking, which can aid in weight reduction efforts. Quick healthy breakfast ideas If you’re in a hurry in the morning to go to school or work, remember, you can always prepare your breakfast in the night or beforehand. Here are some ideas: Upma A savoury breakfast made from semolina (sooji) cooked with vegetables like peas,