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Testing & Diagnosis

Patients with hepatitis B should be screened according to guideline recommendations

SCREENING GUIDELINES FOR HEPATITIS DELTA

Guidelines
Recommendation

American Association for the Study of Liver Diseases (AASLD)1

  • HBsAg+ patients with hepatitis delta risk factors
  • Low/undetectable hepatitis B virus (HBV) DNA and high ALT

Asian Pacific Association for the Study of the Liver (APASL)2

  • Patients with chronic HBV and chronic liver disease

European Association for the Study of the Liver (EASL)3

  • All patients infected with HBV
SCREENING GUIDELINES FOR HEPATITIS DELTA

Guidelines

American Association for the Study of Liver Diseases (AASLD)1

Recommendation

  • HBsAg+ patients with hepatitis delta risk factors
  • Low/undetectable hepatitis B virus (HBV) DNA and high ALT

Guidelines

Asian Pacific Association for the Study of the Liver (APASL)2

Recommendation

  • Patients with chronic HBV and chronic liver disease

Guidelines

European Association for the Study of the Liver (EASL)3

Recommendation

  • All patients infected with HBV

AASLD recommends screening HBV patients with the
following risk factors1:


Persons born in regions with reported high hepatitis delta virus (HDV) endemicity

Persons with multiple sexual partners or any history of sexually transmitted disease

Men who have sex with men

Persons who have ever injected drugs

Persons with high ALT or AST with low or undetectable HBV DNA

Persons infected with the hepatitis C virus or HIV

Map of endemic areas4


Map of endemic countries

The largest populations affected by HDV infection are
in Asia and Africa4

Persons from endemic regions account for about 52% of hepatitis
delta cases in the US5


Pie chart of 52% persons from endemic regions 48% persons from the U.S.

Of those from HDV-endemic regions, nearly 40% are
from China and India5

21%

are from
China

19%

are from
India

Test first for HDV antibodies, then test for HDV RNA to diagnose
active HDV infection1


  • The presence of anti-HDV is evidence of a past or ongoing HDV infection6
  • Anti-HDV titers decline over time in resolved HBV/HDV infections6
  • For patients testing negative but have ongoing risk factors, consider periodic retesting for HDV antibodies1

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ALT=alanine aminotransferase; AST=aspartate aminotransferase; HBsAg=hepatitis B surface antigen; HIV=human immunodeficiency virus.

References: 1. Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67:1560-1599. doi:10.1002/hep.29800 2. Sarin SK, Kumar M, Lau GK, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatol Int. 2016;10(1):1-98. doi:10.1007/s12072-015-9675-4 3. European Association for the Study of the Liver. EASL 2017 clinical practice guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67(2):370-398. doi:10.1016/j.jhep.2017.03.021 4. Miao Z, Zhang S, Ou X, et al. Estimating the global prevalence, disease progression, and clinical outcome of hepatitis delta virus infection. J Infect Dis. 2020;221(10):1677-1687. doi:10.1093/infdis/jiz633 5. Data on file. HDV immigration data analysis. June 2021. 6. Patel EU, Thio CL, Boon D, Thomas DL, Tobian AAR. Prevalence of hepatitis B and hepatitis D virus infections in the United States, 2011–2016. Clin Infect Dis. 2019;69(4):709-712. doi:10.1093/cid/ciz001