Diagnosis of HDV: From virology to non‐invasive markers of fibrosis

Abstract

Hepatitis D viral infection in humans is a disease that requires the establishment of hepatitis B, relying on hepatitis B surface Ag and host cellular machinery to replicate and propagate the infection. Since its discovery in 1977, substantial progress has been made to better understand the hepatitis D viral life cycle, pathogenesis and modes of transmission along with expanding on clinical knowledge related to prevention, diagnosis, monitoring and treatment. The availability of serologic diagnostic assays for hepatitis D infection has evolved over time with current widespread availability, improved detection and standardized reporting. With human migration, the epidemiology of hepatitis D infection has changed over time. Thus, the ability to use diagnostic assays remains essential to monitor the global impact of hepatitis D infection. Separately, while liver biopsy remains the gold standard for the staging of this rapidly progressive and severe form of chronic viral hepatitis, there is an unmet need for clinical monitoring of chronic hepatitis D infection for management of progressive disease. Thus, exploration of the utility of non‐invasive fibrosis markers in hepatitis D is ongoing. In this review, we discuss the virology, the evolution of diagnostics and the development of non‐invasive markers for the detection and monitoring of fibrosis in patients with hepatitis D infection.

Hepatitis Delta: Ready for primetime?

“…Diagnosis of HDV infection is usually made by the detection of anti-HDV followed by measuring HDV RNA, which is also used for treatment monitoring. 22 However, major differences in the performance of the commercially available as well as various in-house HDV RNA assays need to be considered. 23 Importantly, also the method used for RNA extraction has a significant impact on the results.…”

“…The review by Majeed et al in this issue gives an excellent up-to-date overview of the challenges and available data in the virological and clinical evaluation of HBV/ HDV coinfection. 22 Until most recently, the standard of care for antiviral treatment of hepatitis Delta was pegylated interferon alfa (PEG-IFNa), which, despite it has never been approved for this indication, has widely been used off-label for almost two decades. However, treatment success was rather limited.…”

“…Before and during antiviral treatment, clinical and virological assessment is crucial to define the need for treatment as well as the clinical benefit. Diagnosis of HDV infection is usually made by the detection of anti‐HDV followed by measuring HDV RNA, which is also used for treatment monitoring 22 . However, major differences in the performance of the commercially available as well as various in‐house HDV RNA assays need to be considered 23 .…”

“…However, the body of knowledge has been continuously increasing. The review by Majeed et al in this issue gives an excellent up‐to‐date overview of the challenges and available data in the virological and clinical evaluation of HBV/HDV coinfection 22 …”

Advances and Challenges in Managing Hepatitis D Virus: Evolving Strategies

“…Despite its substantial impact, clear monitoring guidelines for diagnosed cases are lacking. Advances in serological testing and non-invasive screening strategies are revolutionizing HDV management, reshaping the field [ 6 ].…”