f As for other chronic viral diseases, quantification of hepatitis delta virus (HDV) loads may be useful for patient management. We describe a one-step quantitative reverse transcription-PCR assay that is reliable and automatable and meets the regulatory authorities' standards for accurate quantification of the major HDV genotypes. It includes an internal control and uses in vitrotranscribed RNAs as standards. Its linearity range is 500 to 1.7 貗 10 11 copies/ml, its sensitivity is around 150 copies/ml, its repeatability is around 15%, and its reproducibility is below 0.25 log 10 copies/ml. H epatitis delta virus (HDV), a satellite of hepatitis B virus, chronically infects more than 15 million people (8,18). It causes the most difficult-to-treat form of viral hepatitis (1, 13). As for other chronic viral infections, quantification of HDV loads may improve patient management and help clarify the pathophysiology of HDV infection. Commercial kits accurately quantify only HDV type 1 (HDV-1) genotypes (2), and other previously published in-house methods do not meet the required criteria for diagnostic method accreditation, especially because of the lack of an internal control (IC) (7,9,10,11,19) or the validation of only HDV-1 genotypes. Here we describe a one-step quantitative reverse transcription-PCR (qRT-PCR) assay that can be automated for the accurate quantification of all of the HDV genotypes that circulate in Europe in the presence of an encapsulated heterologous RNA used as an IC. According to the manufacturer's instructions, the IC is added to each sample before extraction and thus monitors the overall performance of the assay.Nucleic acids were extracted from 500 l EDTA-plasma or serum and eluted in 25 l using NucliSENS easyMAG (bioM茅rieux, Marcy l'Etoile, France) by following the Generic 2.0.1 protocol. A one-step qRT-PCR was performed with the Quantitect Virus kit (Qiagen, Courtaboeuf, France) as described in the supplemental material on a Rotor-Gene 6000 device (Qiagen). Coamplification of IC and HDV RNAs occurred in the same tube. Detection of the IC was done with the Quasar 670-labeled probe and primers provided in the kit (Simplexa Extraction and Amplification Control Set-RNA; Focus Diagnostics, Cypress, CA, and Eurobio, Les Ulis, France). Two forward primers (AgD-F1, AgD-F2) and a reverse primer (AgD-R) were designed (Table 1) to bind conserved parts of the gene encoding the delta antigen, resulting in a PCR product of 129 bp (1158 to 1287). Design of an appropriate probe proved to be difficult due to the high variability (4) and GC content of the HDV genome. Detection was done with an LNABlack Hole Quencher 1 (BHQ1) probe from Eurogentec (17) and compared to the result obtained with a TaqMan-minor groove binder (MGB) probe (Applied Biosystems) binding to the same site. Better sensitivity, accuracy, and fluorescence ratios were obtained with the LNA probe than with the TaqMan probe (see Fig. S2 in the supplemental material). Dually labeled probes like TaqMan can work with a few mismatches (6). Howev...