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Managing Hepatitis B and D
Insights on the Management of Patients With Chronic Hepatitis B and Hepatitis Delta

Released: December 01, 2022

Expiration: March 01, 2026

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HBV and HDV Coinfection and Superinfection

The HDV requires hepatitis B surface antigen (HBsAg) to replicate, so it is only present in people living with chronic hepatitis B (CHB). HDV shares the same modes of transmission as HBV and can be acquired either as an HBV coinfection or superinfection.

HDV infection is important to identify because it is associated with severe and progressive liver disease. Accurate, efficient, and cost-effective methods for the screening, diagnosis, and management of HDV are essential to reducing morbidity and mortality related to HDV infection.

Hepatitis Delta Screening: Whom and How to Test

International guidelines and guidance differ with respect to making recommendations on whom to test for HDV. The 2018 AASLD guidance recommends screening patients based on known HBsAg positivity, individual risk factors, and country of origin, whereas the 2023 EASL guidelines on HDV recommend screening all patients who are HBsAg positive at least once in their lifetime for HDV. The 2016 APASL guidelines do not make specific recommendations on whom to screen.

Screening patients with CHB for HDV should be a 2-step process. Patients should first be screened for hepatitis delta antibodies (anti-HDV). If this test is negative, then the patient can be treated according to standard-of-care management of CHB.

If the antibody test is positive, the patient should then be screened for quantitative HDV RNA. If HDV RNA is positive, this indicates active HDV viremia and the patient should be further assessed for HDV treatment.

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