More Comprehensive HDV Surveillance Needed in High-Risk Individuals

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Overall, only 12% of patients had ever been tested for HDV coinfection.
Overall, only 12% of patients had ever been tested for HDV coinfection.

Low rates of hepatitis D virus (HDV) screening suggest that more comprehensive HDV surveillance is needed in at-risk individuals, according to a study published in Virus Research.

HDV, 1 of the most aggressive forms of viral hepatitis, is dependent on hepatitis B virus (HBV) infection, and therefore may concurrently infect individuals with acute or chronic HBV infection. However, there are limited data on the frequency of HDV infection and the prevalence of HDV antibody and HDV RNA.

Therefore, using electronic medical record data from a tertiary academic health center in the Midwestern United States between 2012 and 2016, researchers sought to determine the pattern of use of HDV testing in patients with known or suspected HBV infection. They evaluated the use of HDV antibody testing among 1007 hepatitis B surface antigen-positive patients.

Overall, only 121 (12%) patients had ever been tested for HDV coinfection, and HDV antibody was detected in 3.3% of these patients. A total of 155 patients were HIV-positive, and of these patients, only 8 (5.1%) had ever been tested for HDV antibody.

The researchers found that gastroenterologists or hepatologists were most likely to order HDV antibody testing (49%), followed by internal medicine physicians (40%) and infectious disease physicians (1.7%).

In addition, the researchers developed and validated a real-time polymerase chain reaction assay to detect HDV RNA. They tested 138 HBV or HBV/HIV coninfected patients and found that 2 patients (2.2%) were HDV RNA-positive.

"Low levels of HDV screening, as was documented in our study, suggest that future studies might focus on use of electronic medical record warning systems or other prompts to improve diagnostic test use in at risk individuals" concluded the authors.

Reference

Safaie P, Razeghi S, Rouster SD, Privitera I, Sherman KE. Hepatitis D diagnostics: utilization and testing in the United States [published online March 27, 2018]. Virus Res. doi: 10.1016/j.virusres.2018.03.013

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