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

• Published in: Liver international Vol. 44; no. 10; pp. 2858 - 2865
• Main Authors: Brichler, Ségolène, Trimoulet, Pascale, Roque‐Afonso, Anne‐Marie, Izopet, Jacques, Thibault, Vincent, Roudot‐Thoraval, Françoise, Chevaliez, Stéphane
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.10.2024; Wiley-Blackwell
• Subjects: Alanine; Alanine transaminase; Antibodies; cascade of diagnosis; Chronic infection; Cirrhosis; diagnosis; Diagnostic systems; Fibrosis; Genotypes; Hepatitis; Hepatitis B e antigen; Hepatitis B surface antigen; hepatitis D; Hepatitis delta virus; Hepatocellular carcinoma; Human health and pathology; Hépatology and Gastroenterology; Infections; Life Sciences; Liver cirrhosis; reflex testing; screening; diagnosis; screening; cascade of diagnosis; hepatitis D; reflex testing
• ISSN: 1478-3223; 1478-3231; 1478-3231
• DOI: 10.1111/liv.16031

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.