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Impact of Universal Screening for HDV in HBV-Infected Patients on Chronic HDV Detection Rate in Israel
David Yardeni1,2, Omer Cividalli2, Bryan Itkowitz3
1Department of Gastroenterology and Liver Diseases, Soroka University Medical Center, Beersheba, Israel.
Insights
Universal screening for Hepatitis delta virus (HDV) in Hepatitis B virus (HBV)-infected patients identifies more cases than risk-based testing. This approach is crucial for detecting HDV infection and improving patient outcomes.
Area of Science:
- Hepatology
- Virology
- Public Health Screening
Background:
- Hepatitis delta virus (HDV) and hepatitis B virus (HBV) co-infection leads to severe liver disease with limited treatment.
- Current testing for HDV antibody (anti-HDV) is insufficient among HBV-infected individuals.
- The American Association for the Study of Liver Diseases (AASLD) recommends risk-based HDV testing, unlike other international guidelines.
Purpose of the Study:
- To compare the efficacy of universal versus risk-based screening for identifying HDV infection in HBsAg-positive patients.
- To evaluate the yield of HDV antibody and RNA detection in different screening strategies.
- To assess the impact of screening on identifying patients with co-infection.
Main Methods:
- Retrospective analysis of HBsAg-positive patients screened for HDV between 2010 and 2022.
- Categorization of patients into high-risk (meeting AASLD criteria) and low-risk groups.
- Comparison of anti-HDV and HDV RNA positivity rates between universal and risk-based screening.
Main Results:
- Universal screening identified 11% more anti-HDV-positive patients compared to risk-based screening.
- AASLD criteria identified only 89% of anti-HDV-positive patients.
- Increased all-cause mortality was observed in the AASLD high-risk group during the study period.
Conclusions:
- Universal screening for HDV in HBsAg-positive patients is more effective in detecting infections than risk-based approaches.
- Current AASLD guidelines may miss a significant proportion of HDV infections.
- Universal HDV screening is encouraged due to the critical importance of early detection and management.
Abstract:
Hepatitis delta virus (HDV) and hepatitis B virus (HBV) co-infection is considered a progressive chronic viral hepatitis where treatment options are limited and significant morbidity and mortality are prevalent. Studies have shown insufficient testing for HDV antibody (anti-HDV) among HBV-infected patients. Unlike European and Asian-Pacific guidelines, the American Association for the Study of Liver Diseases (AASLD) guidelines recommend HDV testing only for high-risk HBV patients. We evaluated the efficacy of universal vs. risk-based screening in identifying HDV infection among HBV patients. We performed a retrospective analysis of patients diagnosed with a positive HBsAg in a tertiary medical center and screened for HDV between 2010 and 2022. 761 patients were found to be HBsAg-positive. 525 (69%) patients met AASLD criteria for HDV screening (high-risk) and 236 (31%) did not (low-risk). Universal screening was performed on 559 (73.4%) patients. In the high-risk group, anti-HDV positivity was found in 33 patients (8.6%). 17 (51.5%) were found to be HDV RNA-positive. In the low-risk group, 4 (2.3%) were found to be anti-HDV-positive. None were found to be HDV RNA-positive. Screening based on AASLD criteria identified only 89% of HDV antibody-positive patients. During the study period, an increased rate of all-cause mortality was observed in the AASLD high-risk group. In this single-center study, universal screening of HBsAg-positive patients identified 11% more anti-HDV-positive patients in comparison to the AASLD-supported high-risk-only screening recommendations. Due to the paramount importance of HDV detection, universal HDV screening in HBsAg-positive patients is encouraged.
