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Hepatitis delta virus testing, epidemiology and management: a multicentre cross-sectional study of patients in London
Kate El Bouzidi1, Wael Elamin2, Katharina Kranzer1
1University College London Hospitals NHS Foundation Trust, Department of Clinical Microbiology and Virology, 2nd Floor, 307 Euston Road, London NW1 3AD, UK.
Insights
Hepatitis delta virus (HDV) testing rates were low with clinic-led approaches but high with laboratory reflex testing. HDV patients often had severe liver disease and responded poorly to interferon treatment.
Area of Science:
- Hepatology
- Virology
- Public Health
Background:
- Hepatitis delta virus (HDV) infection requires testing in all hepatitis B virus (HBV) patients.
- HDV is linked to severe liver disease; interferon is the sole treatment option.
Purpose of the Study:
- Assess anti-HDV antibody testing rates in HBV patients.
- Describe the epidemiology, clinical features, and management of HDV patients across four London hospitals.
Main Methods:
- Clinic-led and laboratory reflex testing strategies were evaluated.
- Retrospective data review of HBV patients from 2005-2012 identified HDV-infected individuals.
Main Results:
- Clinic-led testing yielded a 40% anti-HDV rate; recently diagnosed HBV patients were more likely to be tested.
- Laboratory reflex testing achieved a 99.4% anti-HDV testing rate.
- Fifty-five HDV patients were identified, predominantly immigrants (91%), with high rates of cirrhosis (49%). Interferon treatment showed a 32% virological response.
Conclusions:
- Clinic-led anti-HDV testing rates were suboptimal; laboratory reflex testing significantly improved screening.
- HDV-infected patients presented with advanced liver disease and limited treatment efficacy.
- Recommendations include implementing reflex laboratory testing and further prospective studies for optimized patient management.
Background:
Hepatitis delta virus (HDV) testing is recommended for all patients with hepatitis B virus (HBV) infection. HDV infection is associated with severe liver disease and interferon is the only available treatment.
Objectives:
To determine the rate of anti-HDV antibody testing in HBV patients; and to describe the epidemiology, clinical characteristics and management of HDV-infected patients at four hospitals in London.
Study Design:
The anti-HDV testing rate was estimated by reviewing clinical and laboratory data. Cross-sectional data collection identified HDV-infected patients who had attended the study centres between 2005 and 2012.
Results:
At a centre with clinic-led anti-HDV testing, 40% (67/168) of HBV patients were tested. Recently diagnosed HBV patients were more likely to be screened than those under long-term follow-up (62% vs 36%, P=0.01). At a centre with reflex laboratory testing, 99.4% (3543/3563) of first hepatitis B surface antigen positive samples were tested for anti-HDV. Across the four study centres there were 55 HDV-infected patients, of whom 50 (91%) had immigrated to the UK and 27 (49%) had evidence of cirrhosis. 31 patients received interferon therapy for HDV with an end of treatment virological response observed in 10 (32%).
Conclusions:
The anti-HDV testing rate was low in a centre with clinic-led testing, but could not be evaluated in all centres. The HDV-infected patients were of diverse ethnicity, with extensive histological evidence of liver disease and poor therapeutic responses. Future recommendations include reflex laboratory testing algorithms and a prospective cohort study to optimise the investigation and management of these patients.
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