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Reflex Testing for Hepatitis D Infection: A Unique Opportunity to Reduce Hepatitis D-Related Chronic Liver Disease

Jessica Howell1,2,3,4, Lauren Andersson1,3,5, Miriam T Levy6

  • 1St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.

The Medical Journal of Australia
|April 5, 2026
PubMed

Insights

Chronic hepatitis D virus (HDV) infection, a severe form of viral hepatitis, requires timely diagnosis. Implementing reflex antibody testing for hepatitis B virus (HBV) patients can enable early detection and access to life-saving treatments.

Area of Science:

  • Hepatology
  • Virology
  • Public Health Policy

Background:

  • Chronic hepatitis D virus (HDV) infection is a severe coinfection with hepatitis B virus (HBV).
  • HDV-HBV coinfection significantly increases the risk of cirrhosis, liver cancer, and mortality.
  • Current diagnostic delays in Australia hinder timely treatment initiation.

Purpose of the Study:

  • To advocate for an urgent policy change in HDV testing.
  • To promote the implementation of reflex anti-HDV antibody testing for all HBV-diagnosed individuals.
  • To facilitate earlier diagnosis and treatment of HDV-HBV coinfection.

Main Methods:

  • Policy analysis and advocacy.
  • Review of current diagnostic protocols for viral hepatitis.
  • Call for funding allocation for enhanced screening.

Main Results:

  • Delayed diagnosis of HDV-HBV coinfection is prevalent in Australia.
  • Effective treatments for HDV-HBV coinfection are available.
  • Current screening strategies are insufficient for early detection.

Conclusions:

  • Urgent policy reform is needed to implement reflex anti-HDV antibody testing.
  • Timely diagnosis through reflex testing ensures rapid access to effective treatments.
  • Improved screening strategies are crucial to prevent severe complications of HDV-HBV coinfection.

Keywords:
clinical pathologyhepatitis Bhepatocellular carcinomaliver cirrhosisliver diseasesviral hepatitis

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