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Diagnosis and Management of Hepatitis Delta Virus Infection
Calvin Pan1,2, Robert Gish3,4, Ira M Jacobson5
1Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
Digestive Diseases and Sciences
|June 20, 2023
Summary
Hepatitis D virus (HDV) infection, dependent on hepatitis B virus (HBV), causes severe liver disease. Updated guidelines recommend universal HDV screening for HBV-positive patients, starting with antibody testing.
Area of Science:
- Hepatology
- Virology
- Infectious Diseases
Background:
- Hepatitis D virus (HDV) is a significant cause of severe liver disease, accelerating fibrosis and increasing hepatocellular carcinoma risk in patients with chronic hepatitis B virus (HBV) coinfection.
- HDV relies on HBV for its life cycle, including entry, exit, and replication within hepatocytes.
- Despite its dependency on HBV, HDV infection leads to more rapid and severe liver damage compared to HBV monoinfection.
Purpose of the Study:
- To provide updated guidelines for the testing, diagnosis, and management of hepatitis D virus infection.
- To establish recommendations for screening and initial treatment strategies for HDV.
- To review emerging therapeutic agents for HDV infection.
Main Methods:
- A network data review was conducted on the transmission, epidemiology, natural history, and disease sequelae of acute and chronic HDV infection.
- An expert panel from the Chronic Liver Disease Foundation (CLDF) developed updated guidelines based on current evidence.
- An algorithm was created to outline CLDF recommendations for screening, diagnosis, testing, and initial management of HDV.
Main Results:
- The CLDF recommends universal screening for HDV in all patients positive for Hepatitis B surface antigen (HBsAg).
- Initial screening involves testing for antibodies against HDV (anti-HDV).
- Patients with positive anti-HDV IgG antibodies should proceed to quantitative HDV RNA testing.
Conclusions:
- Universal HDV screening in HBsAg-positive individuals is recommended to identify infection early.
- A stepwise approach involving anti-HDV antibody testing followed by HDV RNA quantification is proposed for diagnosis.
- These guidelines aim to improve the management of HDV infection and address its severe liver disease implications.
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