Photo Credit: Nadzeya Haroshka

Hepatitis delta virus testing in those with chronic hepatitis B is low, and improvements are needed to reduce long-term, liver-related morbidity and mortality.

The incidence of cirrhosis and hepatic decompensation in US veterans with chronic hepatitis B (CHB) was significantly higher in those with concurrent hepatitis delta virus (HDV) infection compared with those without HDV, according to study results published in Gastro Hep Advances.

The HDV testing rate in the overall study cohort was just 16.1%—a finding researchers deemed “concerning.”

Robert J. Wong, MD, and colleagues analyzed data from a national cohort of 27,548 US veterans with CHB from 2010 through 2023 to investigate HDV testing, diagnosis, and liver-related outcomes. Just 4,437 patients underwent HDV testing.

“It should be noted that the 16.1% of CHB patients who completed HDV testing … was nearly double the 8.5% HDV testing rate that was observed in an earlier cohort of veterans from 1999 to 2013, which may reflect some degree of increased HDV awareness over time,” the researchers wrote.

HDV Testing Needed to Ensure Timely Diagnosis & Treatment

Among the 4,437 tested patients, HDV results were positive for 3.25% (n=144).

After excluding patients with cirrhosis or hepatocellular carcinoma at baseline, Dr. Wong and colleagues propensity score matched 71 patients with CHB and HDV to 140 patients with CHB but without HDV. The median follow-up was 5.3 years for the HDV-positive group and 4.5 years for the HDV-negative group.

Per 100,000 person-years, cirrhosis incidence rates were 4.39 in patients with CHB and concurrent HDV compared with 1.30 in patients with CHB without HDV. Hepatic decompensation incidence rates were 2.18 in patients with CHB and HDV compared with 0.41 in patients with CHB without HDV.

The study also found a nonsignificant trend toward higher hepatocellular carcinoma incidence for patients with CHB and HDV. Per 100,000 person-years, the incidence of hepatocellular carcinoma was 1.28 for patients with CHB and HDV compared with 0.41 for patients with CHB alone.

“These findings, taken together with aforementioned low rates of HDV testing, highlight the need to improve implementation of HDV testing for timely diagnosis and treatment to reduce long-term risks of liver-related morbidity and mortality,” the researchers wrote. “This is especially important given the expectation that there will be novel treatment available for HDV in the US in the near future.”