Q&A: Hepatitis D screening, prevention in primary care

Although specialists remain largely responsible for the care of patients with hepatitis D, primary care physicians still play a critical role in the screening and education of patients.

Healio spoke with John D. Scott, MD, MSc, FIDSA, chief digital health officer at UW Medicine, professor of allergy and infectious diseases at University of Washington and medical director at the Liver Clinic at Harborview Medical Center, to learn more about what PCPs can do to help prevent and screen for HDV. Scott has cared for patients with HBV and HDV for two decades.

Healio: What role do PCPs play in the care of patients with HDV?

Scott: The most important thing a PCP can do is to screen for hepatitis B — it is much more common than HDV, which is only seen in context of HBV coinfection. Physicians also should inform patients that HDV can make HBV much worse. Patients are more likely to develop cirrhosis and the treatments are different.

Healio: What can PCPs do to help prevent HDV infection?

Scott: PCPs can screen for HBV and HDV and vaccinate against HBV. If patients are diagnosed with HBV or HDV, referral to either a gastroenterologist, hepatologist or infectious disease expert is warranted. In addition, PCPs can discuss with patients how HDV is spread and how to prevent spread, such as not sharing needles and using barrier protection during sexual intercourse.

Healio: How should PCPs approach screening for HDV in their practice?

Scott: AASLD guidelines recommend screening for HDV in key populations at highest risk, including those from regions of high HDV endemicity, persons with a history of IV drug use, men who have sex with men, individuals coinfected with HCV or HIV, persons with multiple sex partners or any history of sexually transmitted diseases, and those with persistently elevated liver enzymes, despite low or undetectable HBV DNA levels.

Healio: What can PCPs do to increase HBV vaccination in qualified patients?

Scott: Patients should know that the vaccines have been available for 20 years and are safe and effective in preventing infection. The side effects of vaccination are trivial. A newer vaccine, Heplisav-B (Dynavax), only requires two injections given one month apart, so patients can be protected more quickly.

Healio: How can PCPs improve their understanding of the relationship between HBV and HDV?

Scott: There are a number of good resources, including the AASLD website and guidelines for HBV. In addition, the CDC sponsors a web-based curriculum called HBV Online.