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For your patients with HBV, HEPATITIS DELTA adds layers of risk for disease progression1

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BECAUSE OF THE SEVERITY OF HDV, SCREENING IS URGENTLY NEEDED

Recent guidance advises HDV screening for all HBsAg-positive patients2_4

Studies show that the prevalence of HDV in the US varies significantly due to inconsistent screening5

In recent studies, prevalence estimates for HDV in the US range from 1% to 5% of patients with HBV5

Results from a 2023 retrospective analysis of 1444 patients with chronic hepatitis B in the US indicated that 18% of patients with HDV would be missed under US-recommended risk-based screening approaches6

The study analyzed medical records for 11,190 patients diagnosed with chronic hepatitis B infection in a tertiary health system in a multicultural urban area in the US from January 2016 to December 2021. A total of 1444 of the patients with chronic hepatitis B were screened for HDV and 88 (6%) were positive for HDV antibodies.6

Persons from endemic regions are at the most significant risk for hepatitis delta3

In 2022, it was estimated that ~65,000 foreign-born individuals in the US were living with HDV infection7

Endemic regions8:

  • Africa (West Africa, Horn of Africa)
  • Asia (Central and Northern Asia, Vietnam, Mongolia, Pakistan, Japan, Taiwan)
  • Pacific Islands (Kiribati, Nauru)
  • Middle East (all countries)
  • Eastern Europe (Eastern Mediterranean regions, Turkey)
  • South America (Amazonian basin)
  • Other (Greenland)

HDV only infects people with HBV9

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HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; HDV, hepatitis D virus.

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Chronic hepatitis delta infection is the most severe and rapidly progressive form of chronic viral hepatitis9

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HDV infection leads to a faster progression towards liver-related death and hepatocellular carcinoma (HCC)9

Patients infected with HBV/HDV can have more severe disease compared to individuals with HBV monoinfection1,10

2-3× more likely to develop cirrhosis

2-3× higher risk of death or liver transplantation

3-6× higher risk for hepatocellular carcinoma

HCC, hepatocellular carcinoma.

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Screening recommendations

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Recent guidance advises HDV screening for all HBsAg-positive patients2_4

All HBsAg-positive individuals should be screened for HDV at least once.4

– 2025 HBV Guidelines from the European Association for the Study of the Liver

  • The American Association for the Study of Liver Diseases (AASLD) recommends testing of HBsAg-positive persons at risk for HDV, which include8:
  • Immigrants from endemic regions:
    • Africa (West Africa, Horn of Africa)
    • Asia (Central and Northern Asia, Vietnam, Mongolia, Pakistan, Japan, Taiwan)
    • Pacific Islands (Kiribati, Nauru)
    • Middle East (all countries)
    • Eastern Europe (Eastern Mediterranean regions, Turkey)
    • South America (Amazonian basin)
    • Other (Greenland)
  • Low HBV DNA with unexplained ALT elevations should be considered

Map of Endemic Areas11

ALT, alanine aminotransferase; HCV, hepatitis C virus; HIV, human immunodeficiency virus; STD, sexually transmitted disease.

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Challenges in the management of HDV

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  • Antiviral treatment with nucleos(t)ide analogs is NOT effective against the hepatitis delta virus8
  • The goal of HDV treatment is reduction in HDV RNA levels, which typically leads to a normalization of ALT levels8
    • Suppression of HDV replication is associated with normalization of ALT and reduced necroinflammatory activity in the liver8

Resources

More information on hepatitis D
Centers for Disease Control and Prevention (CDC)
Hepatitis D information
Visit CDC.gov
World Health Organization (WHO)
Hepatitis D fact sheet
Visit WHO.int

References

References:

1. Da BL, Heller T, Koh C. Hepatitis D infection: from initial discovery to current investigational therapies. Gastroenterol Rep (Oxf). 2019;7(4):231-245. doi:10.1093/ gastro/goz023 2. Ahn J, Gish RG. Hepatitis D virus: a call to screening. Gastroenterol Hepatol (NY). 2014;10(10):647-686. 3. Terrault NA, Ghany MG. Enhanced screening for hepatitis D in the USA: overcoming the delta blues. Dig Dis Sci. 2021;66:2483-2485. doi:10.1007/s10620-020-06584-w 4. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2025;83(2):502-583. doi:10.1016/ j.jhep.2025.03.018 5. Gish RG, Cohen C, Holden LR, et al. A call to reclassify the delta hepatitis virus as an orphan disease. Hepatol Commun. 2025;9:e0746. doi:10.1097/HC9.0000000000000746 6. Nathani R, Leibowitz R, Giri D, et al. The Delta Delta: Gaps in screening and patient assessment for hepatitis D virus infection. J Viral Hepat. 2023;30:195-200. doi:10.1111/jvh.13779 7. Wong RJ, Brosgart C, Wong SS, et al. Estimating the prevalence of hepatitis delta virus infection among adults in the United States: A meta-analysis. Liver Int. 2024;44(7):1715-1734. doi:10.1111/liv.15921 8. Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67(4):1560-1599. doi:10.1002/hep.29800 9. World Health Organization. Hepatitis D fact sheet. Updated July 25, 2025. Accessed September 18, 2025. https://www.who.int/news-room/fact-sheets/detail/hepatitis-d 10. Brancaccio G, Fasano M, Grossi A, Santantonio TA, Gaeta GB. Clinical outcomes in patients with hepatitis D, cirrhosis and persistent hepatitis B virus replication, and receiving long-term tenofovir or entecavir. Aliment Pharmacol Ther. 2019;49(8):1071-1076. doi:10.1111/apt.15188 11. Miao Z, Zhang S, Ou X, et al. Estimating the global prevalence, disease progression, and clinical outcome of hepatitis delta virus infection. J Infect Dis. 2020;221(10):1677-1687. doi:10.1093/ infdis/jiz633