Large proportion of undiagnosed anti-HDV positive individuals due to lack of testing

Hepatitis D, in hepatitis B surface antigen-positive individuals, may remain undiagnosed due to lack of testing, particularly in primary care settings, according to a poster.

Worldwide, chronic hepatitis D infection often goes unrecognized, partly because it is considered an orphan disease that professionals do not pay much attention to, Adriana Palom, of the Hospital Universitari Vall D’hebron, said during a presentation at The Liver Meeting Digital Experience.

Palom and colleagues analyzed all anti-HDV requests and the adherence to EASL recommendations in HBsAg-positive serum samples from January 2015 to May 2021, with only the first sample per patient analyzed. A central laboratory in Barcelona, Spain, collected HBsAg-positive samples from one academic hospital and 65 primary care centers.

Of the 4,386 patients screened, 8.2% were screened for anti-HDV antibodies with 10.3% of the 360 individuals testing positive. Anti-HDV testing was perform in 7.5% of individuals tested before the EASL guideline recommendations, from 2015 to 2017, and in 9.4% of those tested after the recommendations, from 2018 to 2021 (P = .015).

Of the anti-HDV tests requested, 78% of HBsAg-positive individuals attended an academic hospital and only 22% of those in primary care.

When assessing the impact of EASL guidelines in academic hospitals vs. primary care centers, there was a slight increase in anti-HDV detection in the academic hospital but not in the primary care centers, according to Palom.

“We think that more educational activities and new strategies, such as reflex testing in all surface antigen positives, should be evaluated,” Palom said.