989 Clinicians Fail to Screen for HDV in Patients With HBV Despite Guideline Recommendations

Abstract

INTRODUCTION: Hepatitis D virus (HDV) requires the presence of the hepatitis B virus (HBV) for replication. Due to limited access to testing and lack of reporting, it is unknown how many HBV patients are co-infected with HDV, but estimates state that anywhere from 5% to 42% of those with chronic HBV are also co-infected with HDV. HBV-HDV co-infection is considered one of the most aggressive forms of viral hepatitis as it leads to cirrhosis and hepatocellular carcinoma more rapidly and results in fulminant liver failure in up to 5% of those affected. EASL recommends that in patients with HBV, other causes of chronic liver disease, including HDV, should be tested for. Additionally, AASLD recommends the testing of HBsAg+ positive persons at increased risk for HDV, specifically HIV+ and HCV-Ab+ individuals. We hypothesized that adherence to these guidelines is poor. METHODS: 339 patients who were HBsAg+ were seen at our tertiary academic institution between January 1, 2014, and January 1, 2019. Demographic information including age, sex, and race was captured by chart review as was co-infection with HIV or HCV. We evaluated if patients were ever screened for HDV using the HDV-Ab. RESULTS: 339 patients were HBsAg+, of which 82 were also HBeAg+. 90 (27%) were screened for HDV with only 1 patient (0.3%) testing positive for HDV; 249 (73%) were never screened for hepatitis D. Only 1 of 9 patients (11%) who tested positive for HIV was screened for HDV, and only 1 of 13 patients (8%) who tested positive for HCV was screened for HDV. With respect to race, 111 patients were black, 117 were Asian, 56 were Caucasian, and 55 were other/unknown. The highest rate of screening was noted among Asians at 32%. CONCLUSION: Guidelines recommend screening for HDV in patients with HBV, especially those coinfected with HIV or HCV. Unfortunately, adherence to these guidelines was poor, with the lowest screening rates in those with HIV and HCV who are considered highest risk. With an expected prevalence of 5–42%, many HDV-HBV coinfected patients remain unrecognized and at risk for aggressive liver disease. Lack of awareness to guideline recommendations may contribute to poor screening rates, and it is evident that reflexive screening for patients who have HBV needs to be emphasized.