Outcomes of a 1‐Year Pilot Study Implementing Universal Hepatitis Delta Virus Testing Among Veterans With Chronic Hepatitis B

Abstract

ABSTRACTCurrent US guidelines recommend risk‐based testing for hepatitis delta virus (HDV) in persons with chronic hepatitis B (CHB). While there is debate as to whether a risk‐based or universal testing approach is most effective, limited data exist on universal HDV testing programs in the United States. We performed a 1‐year pilot study evaluating the outcomes of a universal HDV testing approach among US veterans with CHB. All consecutive adults with CHB receiving care at hepatology clinics at a single‐centre Veterans Affairs Health System from 1 October 2022 to 30 September 2023 were prospectively tested for anti‐HDV antibody (anti‐HDV). Patients who were anti‐HDV Ab‐positive were subsequently tested for HDV RNA. Comparison of HDV testing between groups utilised chi‐square testing. A total of 91 consecutive CHB patients (90.0% male, mean age 60.9 ± 14.1 years, 73.9% Asian, 26.1% non‐Asia, 16.5% cirrhosis and 17.1% with active or past history of drug use) had anti‐HDV ordered. Overall, 76.9% (n = 70) completed anti‐HDV testing; 4.3% (n = 3) were positive. HDV RNA testing was ordered in all three patients; two patients completed HDV RNA testing and one had detectable HDV RNA. No significant differences in completion of anti‐HDV testing was observed by age, sex, race/ethnicity, cirrhosis status or drug use history. Among a single‐centre prospective cohort study piloting a universal HDV testing approach, one patient with viremic HDV was identified. Implementing true reflex testing of all CHB patients with anti‐HDV, followed by automated HDV RNA testing for anti‐HDV‐positive patients would improve the HDV testing cascade and timely diagnosis of HDV.