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Screening Impact of Anti-HDV Reflex Testing Among HBsAg-Positive Individuals
Tor Regev-Sadeh1, Ziv Neeman1,2, Naama Schwartz2
1Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3525433, Israel.
Journal of Clinical Medicine
|June 12, 2026
Summary
Reflex testing for Hepatitis D virus (HDV) significantly boosted screening rates and detection among Hepatitis B virus (HBV) carriers. This approach accelerates diagnosis, improving outcomes for patients with chronic viral hepatitis.
Area of Science:
- Hepatology
- Virology
- Public Health
Background:
- Hepatitis D virus (HDV) infection leads to severe chronic viral hepatitis.
- European guidelines recommend universal screening for HDV in Hepatitis B surface antigen (HBsAg)-positive individuals.
- Current screening practices for HDV are not widely implemented.
Purpose of the Study:
- To evaluate the effectiveness of reflex HDV testing.
- To characterize HBV carriers with and without anti-HDV antibodies.
- To assess the impact of reflex screening on coverage, diagnostic yield, and time to diagnosis.
Main Methods:
- Retrospective cohort study using electronic health records (2014-2024).
- Comparison of HBsAg-positive patients screened via reflex testing versus clinical discretion.
- Analysis of screening rates, HDV seropositivity, and time from HBV diagnosis to HDV testing.
Main Results:
- Reflex testing increased HDV screening coverage from 57.5% to 93.1%.
- HDV seropositivity rates doubled, from 3.17% to 6.48% (p=0.02).
- Time to HDV diagnosis decreased significantly, from a median of 37.5 months to 0 months.
Conclusions:
- Anti-HDV reflex testing enhances screening coverage and diagnostic yield.
- Reflex testing facilitates earlier serologic identification of HDV infection.
- Integration into national policies can reduce the burden of HDV infection.
