Screening Recommendations for HDV

The American Association for the Study of Liver Diseases (AASLD) has previously noted that only 10% of those with hepatitis B (HBV) have been diagnosed worldwide, and hepatitis D (HDV), which is often not diagnosed among those with HBV, is estimated to affect 13% of people living with HBV globally.

A key to advancing the diagnosis of HDV, widely considered the most severe form of viral hepatitis, is to increase screening for this form of hepatitis among patients with HBV. Specifically, AASLD recommends screening patients with HBV who also:

• were born in regions with reported high HDV endemicity
• have had multiple sexual partners or any history of sexually transmitted disease
• are men who have sex with men
• have ever injected drugs
• have high alanine transaminase or aspartate aminotransferase with low or undetectable HBV DNA
• are infected with the hepatitis C virus or HIV

“For those at risk for HDV acquisition, periodic retesting is recommended,” the guidance notes. “Anti-HDV–positive patients should have periodic assessment of HDV RNA and HBV DNA. Assessment of HDV-RNA is warranted if ALT elevation occurs following treatment because of the high rates of relapse.”

Further, screening is recommended every 6 months with ultrasound for adults who are hepatitis B-surface antigen (HBsAg) positive and for HDV, as well as others at high risk for hepatocellular carcinoma, including Asian or Black men over 40 years and Asian women over 50 years of age and persons with a first-degree family member with a history of HCC.

Investigators in 2021 concluded that universal screening of hepatitis B in the US could prevent 23,000 deaths from liver disease and liver cancer at an estimated cost saving of $596 million.

--Rebecca Mashaw

References:

Terrault, NA Lok ASF McMahon BJ. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67(4):1560-1599

American Association for the Study of Liver Diseases. World Hepatitis Day 2021. Press release. July 28, 2021. Accessed October 7, 2022. https://www.aasld.org/news/world-hepatitis-day-2021

Toy M, Hutton D, Harris AM, Nelson N, Salomon JA, So S. Cost-effectiveness of one-time universal screening for chronic hepatitis B infection in adults in the United States. Clin Infect Dis. 2021; ciab405. https://doi.org/10.1093/cid/ciab405