Heightened screening could yield higher active hepatitis D diagnoses

Assessing hepatitis D virus patients for viremia, as well as expanded screening for HDV antibodies in hepatitis B virus patients, may help further identify active HDV cases, according to a presentation at UEG Week Virtual.

“Our study nicely showed that the number of confirmed HDV cases in Austria is low, but potentially underestimated due to a lack of testing for anti-HDV antibodies in HBV patients and also a lack of testing for viremia in HDV positive patients,” said Mathias Jachs, MD, of the division of gastroenterology and hepatology at the Medical University of Vienna. “Therefore, we argue that testing all HBV patients for anti-HDV antibodies will increase the diagnostic yield.”

In a retrospective multicenter study involving 10 specialized Austrian hepatitis treatment centers, researchers attempted to determine the national prevalence of HDV as well as define the active HDV cohort in Austria. The study included all patients who tested positive for anti-HDV antibodies between the years 2010 to 2020, and out of the 347 patients who tested positive, 145 (41.8%) were never tested for viremia. Of the 202 patients that underwent HDV-RNA-PCR testing, 126 (62.4%) of these patients were found to be viremic.

“Patients that actually were identified to be viremic ... had a prevalence of advanced chronic liver disease, or cirrhosis, of more than 50%. So, one out of two were actually in an already advanced stage of chronic liver disease. Some of those patients were lost to follow up, but we also saw a high rate of clinical events: that is 11 liver related deaths, seven patients that had to undergo liver transplantation, seven patients that were diagnosed with hepatocellular carcinoma in our study. In the end, 74 patients were included in the active Austrian HDV cohort,” Jachs said.

Of the 74 patients (median age, 46 years; 52.7% men) included in the active HDV cohort, 50% were found to have advanced chronic liver disease. Patients who were determined to have advanced chronic liver disease at baseline were also found to be at highest risk of developing further complications.

“We need to identify all HDV patients and link them to care and hopefully treatment in the future,” Jachs said. “Improved HDV testing and workup strategies will facilitate access to the new antiviral therapies on the horizon.”