Abbas Z, Abbas M. Is there a need for universal double reflex testing of HBsAg-positive individuals for hepatitis D infection? World J Hepatol 2024; 16(3): 300-303 [PMID: 38577532 DOI: 10.4254/wjh.v16.i3.300]
Corresponding Author of This Article
Zaigham Abbas, AGAF, FACG, FACP, FCPS, FRCP, FRCPE, Professor, Department of Hepatogastroenterology and Liver Transplantation, Dr. Ziauddin University Hospital, Clifton, Karachi 75600, Sindh, Pakistan. drzabbas@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Mar 27, 2024; 16(3): 300-303 Published online Mar 27, 2024. doi: 10.4254/wjh.v16.i3.300
Is there a need for universal double reflex testing of HBsAg-positive individuals for hepatitis D infection?
Zaigham Abbas, Minaam Abbas
Zaigham Abbas, Department of Hepatogastroenterology and Liver Transplantation, Dr. Ziauddin University Hospital, Karachi 75600, Sindh, Pakistan
Minaam Abbas, Department of Medicine, University of Cambridge, Cambridge CB2 0SP, United Kingdom
Author contributions: Abbas Z conceived the theme; A review of the literature was done by Abbas Z and Abbas M; Both authors approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zaigham Abbas, AGAF, FACG, FACP, FCPS, FRCP, FRCPE, Professor, Department of Hepatogastroenterology and Liver Transplantation, Dr. Ziauddin University Hospital, Clifton, Karachi 75600, Sindh, Pakistan. drzabbas@gmail.com
Received: December 3, 2023 Peer-review started: December 3, 2023 First decision: January 15, 2024 Revised: January 16, 2024 Accepted: February 22, 2024 Article in press: February 22, 2024 Published online: March 27, 2024
Abstract
Hepatitis D virus (HDV) can infect HBsAg-positive individuals, causing rapid fibrosis progression, early decompensation, increased hepatocellular carcinoma risk, and higher mortality than hepatitis B virus (HBV) mono-infection. Most countries lack high-quality HDV prevalence data, and the collection techniques employed often bias published data. In recent meta-analyses, HDV prevalence in HBsAg-positive patients reaches 5%-15% and is even significantly higher in endemic areas. Since HBV vaccination programs were implemented, HDV prevalence has decreased among younger populations. However, owing to immigrant influx, it has increased in some Western countries. The current practice of HDV screening in HBsAg-positive individuals is stepwise, based on physician’s discretion, and limited to at-risk populations and may require numerous visits. Double reflex testing, which includes anti-HDV testing in all HBsAg-positive individuals and then HDV RNA testing for anti-HDV-positive ones, is uncommon. Reflex testing can identify more HDV infection cases and link identified patients to further care and follow-up. Moreover, laboratory-based double reflex screening is less biased than physician-led testing. Therefore, healthcare providers should learn about reflex testing, and federal and provincial hepatitis control programs should implement laboratory-based double reflex testing to obtain reliable HDV prevalence estimates. The test’s cost-effectiveness depends on the number of HBV-positive patients screened to identify one HDV-positive patient. Such testing may be viable in areas with low HBsAg but high HDV prevalence. However, its economic impact on areas with low HDV prevalence needs further study.
Core Tip: Most countries lack high-quality hepatitis D virus (HDV) prevalence data, and published data are often biased by the collection techniques employed. Currently, HDV diagnosis practice is stepwise. It relies on physician’s discretion and requires numerous visits. Generally, only HBsAg-positive patients highly at risk for HDV are screened. Double reflex testing involves anti-HDV testing of all HBsAg-positive individuals, followed by HDV RNA testing for those who test positive for anti-HDV. This test approach is gaining attention because of the severe implications of HDV coinfection, and emerging as an effective strategy for identifying undiagnosed cases.
