Reflex testing for anti-HDV in HBsAg-positive patients offers high diagnostic yield in a large Central European tertiary care center
Abstract Current guidelines recommend reflex testing for hepatitis D virus (HDV) coinfection in hepatitis B surface antigen (HBsAg)-positive patients over risk-factor based screening. We aimed to evaluate the feasibility and diagnostic yield of reflex anti-HDV testing at a Central European tertiary...
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Nature Portfolio
2024-10-01
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| Online Access: | https://doi.org/10.1038/s41598-024-77737-4 |
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| author | Johannes Bernhard Michael Schwarz Lorenz Balcar Benedikt Hofer Nina Dominik Robert Strassl Stephan Aberle Petra Munda Mattias Mandorfer Michael Trauner Thomas Reiberger Mathias Jachs |
| author_facet | Johannes Bernhard Michael Schwarz Lorenz Balcar Benedikt Hofer Nina Dominik Robert Strassl Stephan Aberle Petra Munda Mattias Mandorfer Michael Trauner Thomas Reiberger Mathias Jachs |
| author_sort | Johannes Bernhard |
| collection | DOAJ |
| description | Abstract Current guidelines recommend reflex testing for hepatitis D virus (HDV) coinfection in hepatitis B surface antigen (HBsAg)-positive patients over risk-factor based screening. We aimed to evaluate the feasibility and diagnostic yield of reflex anti-HDV testing at a Central European tertiary care center. We retrospectively included 560 consecutive patients who had a recorded (first) positive HBsAg test result at the Vienna General Hospital between 2018 and 2022. While reflex anti-HDV testing had been implemented in our hepatitis outpatient clinic (n = 153, ‘reflex testing cohort’), HDV screening needed to be manually ordered in the remaining patients (n = 407, ‘standard testing cohort’). Overall, 98.0% and 65.1% of patients in the reflex and standard testing cohort were screened for anti-HDV, respectively, and the overall seroprevalence of anti-HDV among screened patients was 6.7% (n = 28, reflex testing cohort: 9.3%, standard testing cohort: 5.3%). Risk factors for HDV were present in 49.1% of all included and in 89.3% of anti-HDV positive patients, respectively. Anti-HDV positive patients showed higher ALT (54 [33–83] vs. 29 [19–49] U/L; p = 0.005) and a higher proportion of low-to-undetectable HBV-DNA (61.5% vs. 33.2%; p < 0.001), as compared to anti-HDV negative patients. HDV-RNA PCR was ordered in n = 21/28 (75.0%) of anti-HDV positive patients, and 76.2% had detectable HDV-RNA. Among viremic patients, 75% and 37.5% had significant fibrosis (≥ F2) or cirrhosis (F4), respectively. The prevalence of anti-HDV among HBsAg-positive patients is considerable in a large hospital located in Central Europe. Double reflex testing, i.e., anti-HDV being triggered by the presence of HBsAg and HDV-PCR bring triggered by the presence of anti-HDV, seems warranted to increase the diagnostic yield. |
| format | Article |
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| institution | OA Journals |
| issn | 2045-2322 |
| language | English |
| publishDate | 2024-10-01 |
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| spelling | doaj-art-5ff8d5f088d54ab1a6e5e26d8a9bafb32025-08-20T02:18:32ZengNature PortfolioScientific Reports2045-23222024-10-011411810.1038/s41598-024-77737-4Reflex testing for anti-HDV in HBsAg-positive patients offers high diagnostic yield in a large Central European tertiary care centerJohannes Bernhard0Michael Schwarz1Lorenz Balcar2Benedikt Hofer3Nina Dominik4Robert Strassl5Stephan Aberle6Petra Munda7Mattias Mandorfer8Michael Trauner9Thomas Reiberger10Mathias Jachs11Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of ViennaDivision of Gastroenterology and Hepatology, Department of Medicine III, Medical University of ViennaDivision of Gastroenterology and Hepatology, Department of Medicine III, Medical University of ViennaDivision of Gastroenterology and Hepatology, Department of Medicine III, Medical University of ViennaDivision of Gastroenterology and Hepatology, Department of Medicine III, Medical University of ViennaDivision of Clinical Virology, Department of Laboratory Medicine, Medical University of ViennaCenter for Virology, Medical University of ViennaDivision of Gastroenterology and Hepatology, Department of Medicine III, Medical University of ViennaDivision of Gastroenterology and Hepatology, Department of Medicine III, Medical University of ViennaDivision of Gastroenterology and Hepatology, Department of Medicine III, Medical University of ViennaDivision of Gastroenterology and Hepatology, Department of Medicine III, Medical University of ViennaDivision of Gastroenterology and Hepatology, Department of Medicine III, Medical University of ViennaAbstract Current guidelines recommend reflex testing for hepatitis D virus (HDV) coinfection in hepatitis B surface antigen (HBsAg)-positive patients over risk-factor based screening. We aimed to evaluate the feasibility and diagnostic yield of reflex anti-HDV testing at a Central European tertiary care center. We retrospectively included 560 consecutive patients who had a recorded (first) positive HBsAg test result at the Vienna General Hospital between 2018 and 2022. While reflex anti-HDV testing had been implemented in our hepatitis outpatient clinic (n = 153, ‘reflex testing cohort’), HDV screening needed to be manually ordered in the remaining patients (n = 407, ‘standard testing cohort’). Overall, 98.0% and 65.1% of patients in the reflex and standard testing cohort were screened for anti-HDV, respectively, and the overall seroprevalence of anti-HDV among screened patients was 6.7% (n = 28, reflex testing cohort: 9.3%, standard testing cohort: 5.3%). Risk factors for HDV were present in 49.1% of all included and in 89.3% of anti-HDV positive patients, respectively. Anti-HDV positive patients showed higher ALT (54 [33–83] vs. 29 [19–49] U/L; p = 0.005) and a higher proportion of low-to-undetectable HBV-DNA (61.5% vs. 33.2%; p < 0.001), as compared to anti-HDV negative patients. HDV-RNA PCR was ordered in n = 21/28 (75.0%) of anti-HDV positive patients, and 76.2% had detectable HDV-RNA. Among viremic patients, 75% and 37.5% had significant fibrosis (≥ F2) or cirrhosis (F4), respectively. The prevalence of anti-HDV among HBsAg-positive patients is considerable in a large hospital located in Central Europe. Double reflex testing, i.e., anti-HDV being triggered by the presence of HBsAg and HDV-PCR bring triggered by the presence of anti-HDV, seems warranted to increase the diagnostic yield.https://doi.org/10.1038/s41598-024-77737-4Hepatitis deltaEpidemiologyAntiviralsHepatologyVirology |
| spellingShingle | Johannes Bernhard Michael Schwarz Lorenz Balcar Benedikt Hofer Nina Dominik Robert Strassl Stephan Aberle Petra Munda Mattias Mandorfer Michael Trauner Thomas Reiberger Mathias Jachs Reflex testing for anti-HDV in HBsAg-positive patients offers high diagnostic yield in a large Central European tertiary care center Scientific Reports Hepatitis delta Epidemiology Antivirals Hepatology Virology |
| title | Reflex testing for anti-HDV in HBsAg-positive patients offers high diagnostic yield in a large Central European tertiary care center |
| title_full | Reflex testing for anti-HDV in HBsAg-positive patients offers high diagnostic yield in a large Central European tertiary care center |
| title_fullStr | Reflex testing for anti-HDV in HBsAg-positive patients offers high diagnostic yield in a large Central European tertiary care center |
| title_full_unstemmed | Reflex testing for anti-HDV in HBsAg-positive patients offers high diagnostic yield in a large Central European tertiary care center |
| title_short | Reflex testing for anti-HDV in HBsAg-positive patients offers high diagnostic yield in a large Central European tertiary care center |
| title_sort | reflex testing for anti hdv in hbsag positive patients offers high diagnostic yield in a large central european tertiary care center |
| topic | Hepatitis delta Epidemiology Antivirals Hepatology Virology |
| url | https://doi.org/10.1038/s41598-024-77737-4 |
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