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. 2024 Oct;44(10):2858-2865.
doi: 10.1111/liv.16031. Epub 2024 Aug 8.

The diagnostic cascade for patients with hepatitis delta infection in France, 2018-2022: A cross-sectional study

Ségolène Brichler  1   2 , Pascale Trimoulet  3 , Anne-Marie Roque-Afonso  4   5 , Jacques Izopet  6   7 , Vincent Thibault  8   9 , Françoise Roudot-Thoraval  2   10 , Stéphane Chevaliez  2   11
Affiliations

The diagnostic cascade for patients with hepatitis delta infection in France, 2018-2022: A cross-sectional study

Ségolène Brichler et al. Liver Int. 2024 Oct.

Abstract

Background and aims: Chronic hepatitis D infection is the most severe form of viral hepatitis and can rapidly progress to cirrhosis or hepatocellular carcinoma. Despite recommendations for systematic screening of hepatitis B surface antigen (HBsAg)-positive individuals, data from real-world studies have reported a low frequency of hepatitis D (or delta) virus (HDV) screening. Our cross-sectional analysis evaluated the diagnostic cascade for hepatitis D infection in tertiary centres and described the characteristics of HDV-positive patients.

Methods: A total of 6772 individuals who tested HBsAg positive for the first time between 2018 and 2022 were retrospectively included. Demographic, clinical and laboratory data were analysed.

Results: A total of 5748 HBsAg-positive individuals (84.9%) were screened for HDV infection. The screening rate varied from 63% to 97% according to the screening strategy used in the centres including or not HDV reflex testing. The prevalence of HDV infection was 6.3%. HDV RNA levels were determined in 285 of the 364 (78.3%) HDV antibody screening-positive patients, and 167 (58.6%) had active HDV infection. 66.8% were males, with a mean age of 44.9 years. A total of 97.5% were born abroad, and 92.9% were HBeAg negative. At the time of diagnosis, HDV RNA levels were 6.0 Log UI/mL; 60.1% had alanine aminotransferase >40 U/L, and 56.3% had significant fibrosis (≥F2), including 41.6% with cirrhosis. The most common genotype was HDV-1 (75.4%). Coinfections were not uncommon: 7.4% were HIV positive, and 15.0% were HCV antibody positive.

Conclusions: The present study highlights the need for increased screening and monitoring of HDV infection. Reflex testing helps to identify HDV-infected individuals.

Keywords: cascade of diagnosis; diagnosis; hepatitis D; reflex testing; screening.

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References

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