French National Reference Center for Hepatitis B, C and D Viruses, Laboratoire de Microbiologie Clinique, Hôpital Avicenne, Bobigny, France.
"Team Viruses, Hepatology, Cancer", Institut de Recherche Biomédicale INSERM U955, Créteil, France.
Liver Int. 2024 Oct;44(10):2858-2865. doi: 10.1111/liv.16031. Epub 2024 Aug 8.
Chronic hepatitis D infection is the most severe form of viral hepatitis and can rapidly progress to cirrhosis or hepatocellular carcinoma. Despite recommendations for systematic screening of hepatitis B surface antigen (HBsAg)-positive individuals, data from real-world studies have reported a low frequency of hepatitis D (or delta) virus (HDV) screening. Our cross-sectional analysis evaluated the diagnostic cascade for hepatitis D infection in tertiary centres and described the characteristics of HDV-positive patients.
A total of 6772 individuals who tested HBsAg positive for the first time between 2018 and 2022 were retrospectively included. Demographic, clinical and laboratory data were analysed.
A total of 5748 HBsAg-positive individuals (84.9%) were screened for HDV infection. The screening rate varied from 63% to 97% according to the screening strategy used in the centres including or not HDV reflex testing. The prevalence of HDV infection was 6.3%. HDV RNA levels were determined in 285 of the 364 (78.3%) HDV antibody screening-positive patients, and 167 (58.6%) had active HDV infection. 66.8% were males, with a mean age of 44.9 years. A total of 97.5% were born abroad, and 92.9% were HBeAg negative. At the time of diagnosis, HDV RNA levels were 6.0 Log UI/mL; 60.1% had alanine aminotransferase >40 U/L, and 56.3% had significant fibrosis (≥F2), including 41.6% with cirrhosis. The most common genotype was HDV-1 (75.4%). Coinfections were not uncommon: 7.4% were HIV positive, and 15.0% were HCV antibody positive.
The present study highlights the need for increased screening and monitoring of HDV infection. Reflex testing helps to identify HDV-infected individuals.
慢性丁型肝炎感染是病毒性肝炎中最严重的形式，可迅速进展为肝硬化或肝细胞癌。尽管建议对乙型肝炎表面抗原（HBsAg）阳性个体进行系统筛查，但来自真实世界研究的数据报告丁型肝炎（或德尔塔）病毒（HDV）筛查频率较低。我们的横断面分析评估了三级中心丁型肝炎感染的诊断流程，并描述了 HDV 阳性患者的特征。
回顾性纳入 2018 年至 2022 年间首次检测 HBsAg 阳性的 6772 例个体。分析了人口统计学、临床和实验室数据。
共有 5748 例 HBsAg 阳性个体（84.9%）接受了 HDV 感染筛查。根据包括或不包括 HDV 反射检测的中心使用的筛查策略，筛查率从 63%到 97%不等。HDV 感染的患病率为 6.3%。在 364 例 HDV 抗体筛查阳性患者中，有 285 例（78.3%）确定了 HDV RNA 水平，其中 167 例（58.6%）有活动性 HDV 感染。66.8%为男性，平均年龄为 44.9 岁。他们均为出生于国外，92.9%为 HBeAg 阴性。在诊断时，HDV RNA 水平为 6.0 Log UI/mL；60.1%的患者丙氨酸氨基转移酶（ALT）>40 U/L，56.3%有显著纤维化（≥F2），包括 41.6%的患者有肝硬化。最常见的基因型是 HDV-1（75.4%）。合并感染并不少见：7.4%为 HIV 阳性，15.0%为 HCV 抗体阳性。
本研究强调需要增加对 HDV 感染的筛查和监测。反射测试有助于识别 HDV 感染个体。
