Characterising Hepatitis D Virus in the UK From 2011 to 2021

Area of Science:

• Hepatology
• Virology
• Public Health

Background:

• Hepatitis B virus (HBV) and Hepatitis D virus (HDV) coinfection is associated with accelerated liver disease progression.
• Current UK guidelines recommend HDV screening for all individuals with HBV.
• Limited data exists on HBV/HDV coinfection prevalence and testing pathways in the UK.

Purpose of the Study:

• To investigate HDV testing pathways among individuals tested for HBV in the UK.
• To describe the characteristics and outcomes of individuals with HDV coinfection.
• To inform targeted interventions for improved testing, diagnosis, and care linkage.

Main Methods:

• Analysis of national HBV testing data and HDV testing data from 11 UK laboratories (2011-2021).
• Established a cohort of individuals tested for HDV.
• Collected demographic, clinical, treatment, and laboratory data for HDV-RNA positive individuals.

Main Results:

• Only 42% of newly diagnosed HBV patients in England were linked to an HDV test.
• 5.0% tested positive for anti-HDV, with 45.7% of those tested being HDV-RNA positive.
• Among HDV-RNA positive individuals, 94.3% were non-UK born, 49% received treatment, and 48% had cirrhosis; 10% died, primarily from liver disease.

Conclusions:

• HDV testing rates in the UK fall short of recommended guidelines, including RNA testing for anti-HDV positive cases.
• Significant improvements are needed in the patient care pathway for diagnosis, linkage, retention in care, and treatment access for HBV/HDV coinfected individuals.
• Targeted interventions are crucial, especially for non-UK born populations, to address suboptimal testing and care.