Parfut Assilina, Tripon Simona, Gantner Pierre, Chaffraix Fréderic, Laugel Elodie, Wendling Marie-Josée, Erol Furkan, Wiedemer Carine, Doffoel Michel, Saviano Antonio, Royant Maude, Habersetzer François, Fafi-Kremer Samira, Velay Aurélie
Virology Laboratory, Strasbourg University Hospital, Strasbourg, France.
Service Expert de Lutte Contre les Hépatites Virales d'Alsace (SELHVA), Pôle Hépato-Digestif, Strasbourg University Hospital, Strasbourg, France.
J Clin Virol. 2024 Apr;171:105650. doi: 10.1016/j.jcv.2024.105650. Epub 2024 Feb 3.
Hepatitis Delta virus (HDV) infection is a major cause of liver-related morbidity and mortality in patients infected with HBV, with a global HDV prevalence uncertain. In France, 2 to 5 % of HBs antigen (HBsAg) carriers present anti-HDV antibodies (anti-HDV). The EASL recommends testing for anti-HDV in all HBsAg-positive patients. Since January 2022, we have systematically carried out anti-HDV serology when a positive HBsAg is discovered (new HBsAg carriers).
We evaluated the benefit of anti-HDV reflex testing after one year of practice by comparing anti-HDV and HBsAg serology data over the last six years, among the new HBsAg carriers and all the HBsAg carriers.
HBsAg and anti-HDV were screened using the Abbott Architect HBsAg quanti kit and the DIA.PRO HDVAb kit. Serological, demographic, virological, and clinical data were analyzed.
Implementing anti-HDV reflex testing leads to more than a 2-fold increase in diagnoses of HDV infection among all HBsAg carriers. If the anti-HDV positive rate remains stable among the new HBsAg carriers, a significant increase in the anti-HDV positive rate from 6.8 % to 10.3 % was observed considering all HBsAg carriers. Interestingly, the discovery of anti-HDV carriage increased from 3.9 % to 6.5 % in 2022, allowing earlier identification of HBV-HDV-infected patients and a fast referral to hepatologists for adequate clinical management and, in some cases, the introduction of bulevirtide-based therapy.
Our preliminary results at one year seem promising and evaluating the cost-effectiveness of reflex tests in real life with feedback would be helpful.
丁型肝炎病毒（HDV）感染是乙型肝炎病毒（HBV）感染者肝脏相关发病和死亡的主要原因，全球HDV流行率尚不确定。在法国，2%至5%的乙肝表面抗原（HBsAg）携带者存在抗HDV抗体（抗HDV）。欧洲肝脏研究学会（EASL）建议对所有HBsAg阳性患者进行抗HDV检测。自2022年1月以来，当发现HBsAg阳性（新的HBsAg携带者）时，我们系统地开展了抗HDV血清学检测。
通过比较过去六年中新的HBsAg携带者和所有HBsAg携带者的抗HDV和HBsAg血清学数据，评估实施一年的抗HDV反射检测的益处。
使用雅培Architect HBsAg定量试剂盒和DIA.PRO HDVAb试剂盒筛查HBsAg和抗HDV。分析血清学、人口统计学、病毒学和临床数据。
实施抗HDV反射检测使所有HBsAg携带者中HDV感染的诊断增加了两倍多。如果新的HBsAg携带者中抗HDV阳性率保持稳定，那么考虑所有HBsAg携带者时，抗HDV阳性率从6.8%显著增加到10.3%。有趣的是，2022年抗HDV携带的发现率从3.9%增加到6.5%，这使得能够更早地识别HBV-HDV感染患者，并迅速转诊至肝病专家处进行适当的临床管理，在某些情况下，还能开始基于布列韦肽的治疗。
我们一年的初步结果似乎很有前景，在现实生活中通过反馈评估反射检测的成本效益将有所帮助。
