HDV testing underused in HBV monoinfection, HBV/HIV coinfection

CHICAGO — Researchers found that HDV testing was underused in varying patient populations, including patients with hepatitis B and patients with HBV/HIV coinfection, according to a presentation at Digestive Disease Week.

“The recommendations for testing for the delta virus are different among the different guidelines,” Parham Safaie, MD, from the University of Cincinnati, said in a presentation. “For instance, the AASLD guideline recommend testing for the delta antibody of the virus only in those individuals at risk, including subjects from high endemic areas and those with history of intravenous drug use. Whereas the EASL ... recommend for HDV, systematically, in all subjects with positive surface antigen. With that background in mind, in this work we sought to determine the frequency of testing for the delta virus among those with chronic HBV infection [and HBV/HIV coinfection].”

To determine the frequency of testing for HDV among patients with HBV and patients with HBV/HIV coinfection, the researchers extracted de-identified data of 1,007 patients who were HBsAg-positive and examined the characteristics of each patient. There were 621 men, 53% were white and 99.2% had no history of intravenous drug use.

The researchers found 155 patients with HIV and, from the total cohort, 121 patients who had received HDV Ab testing. Only eight of the patients with HIV had received testing. Four HIV-negative patients were identified as HDV/HBV coinfected.

Compared with the 121 tested patients without HDV, the patients with HDV were older (45 vs. 57 years), had higher mean alanine aminotransferase levels (314 vs. 343) and mean HDV DNA levels (4.27 E+06 vs. 6.25 E+06; P = .02), and nearly all were HBeAg-negative/HBeAb-positive (P = .04).

Gastroenterology and hepatology specialists were the physician groups that ordered HDV testing most frequently (49.6%), followed by physicians in internal medicine (40.2%), other specialties (8.5%) and infectious disease specialists (1.7%).

“The data on antibody testing seems inadequate in both of these groups, although this study is very limited, very small number of positive subjects and we do not know if the tested group was preselected because of higher prevalence of HDV,” Safaie concluded, regarding study limitations. “Also, [the] lack of availability in RNA testing in our institution and many other institutions is another limitation.” – by Talitha Bennett

References:

Safaie P, et al. Abstract 741c. Presented at: Digestive Disease Week; May 6-9, 2017; Chicago.

Disclosure: Safaie reports no relevant financial disclosures.