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Is hepatitis delta underestimated?
Margarita Papatheodoridi1, George V Papatheodoridis2
1Institute of Liver and Digestive Health, University College of London, London, UK.
Summary
Hepatitis D virus (HDV) infection is likely underestimated and underdiagnosed globally. All Hepatitis B surface antigen-positive patients should be screened for HDV due to increased risks of severe liver disease.
Area of Science:
- Hepatology
- Virology
- Infectious Diseases
Background:
- Hepatitis D virus (HDV) is a significant concern in Hepatitis B surface antigen (HBsAg)-positive individuals, particularly those with co-infections or in endemic areas.
- Despite public health improvements, HDV prevalence remains stable or increased in some regions due to ongoing spread and migration.
- Recent meta-analyses show conflicting prevalence data, ranging from 0.16%–1.00% globally and 4.5%–14.6% in HBsAg-positive patients.
Purpose of the Study:
- To highlight the underestimated prevalence and underdiagnosis of Hepatitis D virus.
- To emphasize the increased risk of cirrhosis and hepatocellular carcinoma (HCC) associated with HDV infection, especially with HIV co-infection.
- To advocate for universal HDV screening in HBsAg-positive patients.
Main Methods:
- Review of recent meta-analyses and epidemiological data on HDV prevalence.
- Analysis of risk factors and clinical outcomes associated with HDV infection.
- Assessment of current diagnostic challenges and screening practices.
Main Results:
- Estimated global HDV prevalence varies significantly, with 12–70 million cases worldwide.
- HDV infection substantially increases the risk of cirrhosis and HCC compared to HBV mono-infection.
- HIV co-infection further elevates the risk of severe liver disease progression in HDV patients.
Conclusions:
- Hepatitis D virus infection is likely underestimated and underdiagnosed in clinical practice.
- HDV poses a significant threat, leading to severe liver morbidity and mortality.
- Routine screening for HDV is recommended for all HBsAg-positive patients.
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