Chronic hepatitis D represents the most severe form of viral hepatitis and is associated with higher rates of advanced fibrosis, cirrhosis and hepatocellular carcinoma than hepatitis B monoinfection. It is caused by the hepatitis D virus (HDV), a defective RNA virus that requires co-infection with hepatitis B (HBV) for hepatocyte entry and propagation. Accurate prediction of liver disease sequelae and treatment response using currently available serological biomarkers remains challenging. This article reviews peripheral biomarkers in HDV, including novel biomarkers of HBV activity, exploring their potential clinical utility and areas for future development. Peripheral biomarkers capable of risk stratifying patients with HDV, monitoring or predicting treatment response and elucidating the natural history of infection (including the complex relationship with HBV), would enable individualised care and early identification of those at greater risk of developing advanced liver disease. Establishing the role of these biomarkers in larger, ethnically diverse populations both on existing treatments and in the context of emerging antiviral therapies will be imperative going forward.
This study aims to develop a nomogram model intended for predicting long-term mortality in patients suffering from hepatitis B-related cirrhosis associated with Portal vein thrombosis (PVT). A total of 961 patients were recruited from January 2015 to December 2023, forming the training cohort. We analysed independent risk factors affecting 5-year mortality through COX regression, from which we constructed a nomogram. To assess the nomogram's utility, we employed the receiver operating characteristic (ROC) curve, C-index, calibration curves, and decision curve analysis (DCA). The independent prognostic factors retained in the final model for patients with hepatitis B-related cirrhosis complicated by PVT included age (HR = 1.09, 95% CI: 1.06-1.11; p < 0.001), leukocyte count (WBC) (HR = 1.09, 95% CI: 1.03-1.17; p = 0.002), and the neutrophil-to-lymphocyte ratio (NLR) (HR = 1.29, 95% CI: 1.22-1.35; p < 0.001), along with serum sodium (HR = 0.94, 95% CI: 0.90-0.98; p = 0.005). The AUROC values for the nomogram were 0.906 (95% CI: 0.891-0.921) in the training cohort and 0.910 (95% CI: 0.885-0.927) in the validation cohort, demonstrating improved performance and discriminatory ability compared to current models, including CTP and MELD scores. Age, leukocyte count (WBC), NLR, and serum sodium emerged as independent risk factors impacting prognosis for patients with hepatitis B cirrhosis and PVT within 5 years. The nomogram developed in this research holds significant potential for accurately predicting the outcomes of these patients within 5 years.
Liver cancer is the second leading cause of premature cancer mortality globally, whose main causes-HBV, HCV, MASH and alcohol use-are preventable. Viral hepatitis' carcinogenicity is not as well-known as the risk of lung cancer from smoking, leading to rising rates of liver cancer worldwide. The aim of this study was to compare the risk of liver cancer in HBV, HCV, HDV, MASH and alcohol consumption with the better-known risk of lung cancer associated with smoking. We extracted the relative risk of liver cancer from HBV, HCV, HDV, MASH, and alcohol use and the relative risk of lung cancer from smoking from previous studies. We included cohort, case-control and nested case-control studies published as original articles. Odds ratios for each factor were pooled globally and by region to test for significant differences. One hundred and twenty-six studies with 86,097,714 participants were included. Relative to the risk of lung cancer and currently smoking (OR 6.0), HBV (OR 15.2, p < 0.001), HCV (OR 12.8, p < 0.01) and HDV (OR 23.5, p < 0.01) were significantly associated with a higher risk of liver cancer, while MASLD (OR 2.6, p < 0.01) and alcohol use (OR 2.4, p < 0.001) were significantly associated with a lower risk of liver cancer. There was no statistically significant difference in liver cancer risk across regions. These findings highlight that viral hepatitis is a carcinogenic infectious disease. Better integration of HCC surveillance within the management of viral hepatitis is critical.
Chronic hepatitis B (CHB) and hepatitis D virus (HDV) coinfection are major causes of cirrhosis and hepatocellular carcinoma. The geographic distribution of CHB and alignment of anti-HDV testing with CHB burden remain poorly defined. We aimed to examine if anti-HDV testing and seropositivity align with areas of highest CHB burden. Adults with CHB (2014-2022) were identified using a validated serologic algorithm in the provincial laboratory database capturing HBV/HDV serology. Cases were geolocated to Aggregate Dissemination Areas (ADAs), linked to Alberta Health Services zones and rural-urban continuum levels. Age- and sex-standardized CHB prevalence was calculated per ADA using the 2016 Canadian Census. Descriptive mapping, global spatial autocorrelation and local hotspot analysis were used to assess spatial clustering. Among 8317 persons with CHB, the provincial age- and sex-standardized prevalence was 1.70 per 1000 population (95% CI, 1.66-1.74). Prevalence ranged from 2.15 per 1000 in metropolitan areas to 0.40 per 1000 in remote regions and was higher in Calgary than Edmonton (2.53 vs. 1.73 per 1000). Overall, 17.5% of CHB patients were tested for anti-HDV, and 4.1% of those tested were anti-HDV positive. CHB prevalence hotspots were concentrated in metropolitan ADAs, whereas hotspots of anti-HDV testing and positivity showed only partial overlap with these high-burden areas. CHB burden in Alberta is geographically clustered, particularly within specific neighbourhoods of metropolitan cities, whereas anti-HDV testing remains infrequent and only partially aligned with high-burden areas. Reflex or systematic anti-HDV testing, paired with geographically informed outreach, may improve case detection.
Chronic Hepatitis B disease requires lifelong monitoring to prevent complications such as cirrhosis and hepatocellular carcinoma. Despite structured care pathways, non-attendance within UK secondary care remains challenging. This scoping review aimed to synthesise existing evidence on factors influencing non-attendance at secondary care appointments and strategies to improve appointment adherence among people living with Chronic Hepatitis B. Eligibility Criteria: Peer-reviewed sources examining adults with Hepatitis B attendance at UK secondary care services. Grey literature was excluded. Sources of Evidence: Searches were performed in CINAHL Ultimate, Medline, Embase, Scopus and APA PsycINFO. Data were charted using a structured data extraction form and synthesised narratively. Eleven studies met the inclusion criteria. Identified barriers included patient-related factors (e.g., limited health literacy, stigmatisation, competing priorities), system-level challenges (e.g., appointment scheduling and accessibility) and cultural or language barriers. Psychological factors, including fear of diagnosis and treatment side effects, were also reported. Reported strategies included patient education, culturally tailored interventions, reminder systems (e.g., SMS and telephone calls) and integrated care models involving community outreach. Non-attendance among people with chronic Hepatitis B in secondary care is influenced by a complex interplay of personal, social and systemic factors. Interventions that address multiple barriers, particularly those that incorporate culturally sensitive approaches and reminder systems, may improve engagement. Further research is needed to co-design and evaluate interventions with affected communities.
Little is known about hepatitis B virus (HBV) and Hepatitis D virus (HDV) coinfection in the UK. HDV screening is recommended among all individuals with HBV, with coinfection associated with increased disease progression. Using data on HDV testing, shared by 11 laboratories in the UK who reported undertaking HDV testing, and national testing data for HBV we established a cohort of individuals tested for HDV, investigating testing pathways, describing characteristics and outcomes of those HDV-RNA positive to inform targeted interventions for testing, diagnosis and linkage to care. Demographic information, clinical assessments, treatment and recent laboratory results from NHS trusts, and through linkage to national healthcare datasets was collected for HDV-RNA positive individuals. Between 2011 and 2021, 42% of individuals newly diagnosed with HBV in England were linked to an HDV test. Anti-HDV positivity was 5.0%, 55.8% were HDV-RNA tested and 45.7% were ever HDV-RNA positive. HDV-RNA positivity in the absence of an anti-HDV result was 6.4%. Among individuals who were HDV-RNA positive, 94.3% were non-UK born, with 24 different primary languages reported, 49% had evidence of treatment, and 48% had evidence of cirrhosis. 10% had died of which 58.4% died of liver disease. In conclusion, our findings indicate that HDV testing in HBV positive individuals in the UK is sub-optimal against testing guidelines, including RNA testing among those who are anti-HDV positive. Considerable work is needed to improve the patient care pathway, to ensure patients are appropriately diagnosed, linked and retained in care, with adequate access to treatment.
Chronic hepatitis B virus (HBV) infection is a global public health problem, and many regions of Sub-Saharan Africa are disproportionately affected, including Cameroon, where prevalence has previously been shown to be high. This study aimed to provide up-to-date estimates of HBV prevalence in Cameroon. We searched Medline, Global Health, Embase, Web of Science, Cochrane Library, Africa Index Medicus and the Journal of Health Science and Disease at the University of Yaounde. We included studies reporting HBV surface antigen (HBsAg) prevalence in the general population and subpopulations. A random-effects meta-analysis was used to generate pooled estimates of HBsAg prevalence, overall and for population subgroups including those considered at relatively higher-risk and relatively lower-risk of HBV infection. Heterogeneity was assessed using the index of heterogeneity (I2). Quality was assessed using the Joanna Briggs Institute critical appraisal tool. Out of 1236 records, 92 papers with 100 studies were included in the meta-analysis. Overall prevalence of HBV in Cameroon was 9.98% (95% confidence interval [CI] 9.00-11.02) with high heterogeneity (I2 = 98.10%). The prevalences for relatively lower-risk and higher-risk populations were8.94% (95% CI 7.84-10.11) and 12.70% (95% CI 10.28-15.32), respectively. In subgroup analyses, we found that sex, geographical area (regions), population risk groups and study design were the main sources of heterogeneity. Overall, HBV prevalence remains high in Cameroon. Our findings suggest an urgent need for health interventions to halt the spread of the disease, with particular attention needed for males and regions with the highest prevalence.
To close gaps in implementing care of people with hepatitis B virus (HBV) infection in resource-limited settings, we evaluated the accuracy of a novel liver point-of-care ultrasound (POCUS) protocol for hepatitis (PUSH) among front-line non-radiology healthcare workers in Zambia. At University Teaching Hospital in Lusaka, Zambia, from March to June 2024, we trained four nurses and six physicians with experience in HBV management, but not in ultrasound (US), in the PUSH protocol, which includes visualizing the liver in three windows (epigastric, subcostal and right transcostal) to identify cirrhosis-suggestive features and liver lesions suspicious for hepatocellular carcinoma (HCC). Then, consecutive adult participants with chronic hepatitis B (PWHB) alone or HBV/HIV coinfection underwent PUSH with operators blinded to clinical data. We evaluated the accuracy of PUSH for significant fibrosis and cirrhosis using transient elastography (TE) as the reference standard test (RST) and for liver lesions that were possible HCC using a comprehensive abdominal ultrasound by an experienced radiographer as the RST. Nonparametric analysis of the receiver operating curve (ROC) for PUSH was adjusted for operator type (doctor vs. nurse), sex and HIV status. Among 197 PWHBs analysed, 69.5% were taking HBV antivirals and 27.9% had HBV/HIV. According to RSTs, 17.7% of PWHBs had significant fibrosis, 11.6% had cirrhosis and 3.5% had liver lesions. PUSH had low accuracy for significant fibrosis, with sensitivity of 8.3% (17.5-41.4), specificity of 100.0% (96.1-100) and an area under the curve (AUROC) of 0.54 (0.43-0.65), moderate accuracy for cirrhosis, with sensitivity of 60.9% (38.5-80.3), specificity of 97.7% (94.2-99.4) and AUROC of 0.79 (0.69-0.89), and higher accuracy for liver lesions, with 85.7% (42.1-99.6) sensitivity, 98.4% (95.5-99.7) specificity, AUROC of 0.92 (0.78-1.00). After an expedited training, front-line nurses and physicians treating HBV in Zambia were able to use PUSH to diagnose cirrhosis with moderate accuracy and liver lesions with high accuracy, although confidence intervals around performance estimates were wide. Liver POCUS including PUSH may be useful in HBV management when laboratory systems and TE are lacking.
As little is known about the disease burden of chronic hepatitis D virus (HDV) infection, this study examined health-related quality of life (HRQoL) and fatigue at different disease stages. This was a real-world quantitative cross-sectional survey of patients in Germany, Italy, Spain and the USA. Patients were recruited via their treating physicians. Patients who had received bulevirtide for hepatitis B or treatment licensed for HDV were excluded. Of 211 patients, 41% were noncirrhotic (F0-F3); 20% had liver cirrhosis with normal function (compensated); 20% had liver cirrhosis (F4) with impaired function (decompensated); 19% had hepatocellular carcinoma (HCC). Mean (standard deviation; SD) age was 54.5 (11.5) years, 75% were male. ANOVA showed a significant decrease (indicating poorer HRQoL) in EQ-5D-3L visual analogue scale (VAS) scores and index values with worsening disease stage and increasing severity (all p < 0.0001). All domain scores of the Hepatitis Quality of Life Questionnaire v2 (except positive wellbeing) worsened with progressing disease and increasing symptom severity (all p ≤ 0.0001). Mean Fatigue Severity Scale (FSS) total scores also increased, indicating greater fatigue, with worsening of disease and increasing symptom severity (both p < 0.0001). HDV infection significantly impacts patients' HRQoL and fatigue, particularly for patients at later disease stages. Treatments that slow disease progression, reducing the burden of HDV infection, are needed.
Hepatitis D is common among immigrants in Canada, who account for approximately 23% of the population and tend to originate from high-endemic countries. Mortality rates are notably high among those with chronic infections, and immigrants are less likely to engage in screening and treatment services. This paper aims to assess the cost-utility of screening and treating Hepatitis D Virus (HDV)-positive immigrants in Canada compared with a scenario in which no screening is conducted. This analysis takes a public-payer perspective, uses a lifetime time horizon with a 1.5% annual discount rate, and expresses costs in 2023 Canadian dollars. A state-transition model representing the natural progression of chronic hepatitis B and hepatitis D was developed in TreeAge Pro and mapped onto three interventions: screening and treatment with bulevirtide; screening and treatment with pegylated interferon alfa-2a; and screening and treatment with both bulevirtide and pegylated interferon alfa-2a. The analysis was conducted in accordance with the guidelines of Canada's Drug Agency. The incremental cost-effectiveness ratio (ICER) was estimated for each intervention. Model sensitivity was performed using both univariate and probabilistic sensitivity analyses. All screening and treatment strategies resulted in a reduction in cases of decompensated cirrhosis, hepatocellular carcinoma and liver death, with combination therapy demonstrating the most favourable outcomes. Nevertheless, HDV screening and treatment with pegylated interferon alfa-2a monotherapy was the only cost-effective strategy (ICER: $23,177/QALY). While monotherapy with pegylated interferon alfa-2a proved cost-effective, combination therapy with bulevirtide is likely more clinically effective and may be cost-effective if treatment costs decrease significantly.
Hepatitis B (HBV), hepatitis C (HCV), and HIV remain public health challenges despite effective treatments and preventive options. Infections are often asymptomatic, leading to undiagnosed cases, onward transmission, and preventable morbidity and mortality. In the Netherlands, disease burden is concentrated in specific populations, with many undetected infections. We estimated HBV, HCV, and HIV seroprevalence, identified determinants, and assessed trends over 20 years using data from 14,444 participants aged 15-79 years from three nationwide cross-sectional serosurveys (PIENTER: 1995-1996, 2006-2007, and 2016-2017). Participants completed questionnaires on demographics, behaviour, and socio-economic factors, and serum samples were tested for HBV and HCV in all rounds and HIV in 2017. Seroprevalence estimates were weighted to the Dutch population, trends were analysed using weighted Poisson regression, and determinants were evaluated using multivariable Poisson regression. Weighted HBV seroprevalence remained stable across surveys (3%-5% past or present infection; < 0.4% active infection). HBV prevalence was highest among first-generation migrants, with older age, migration background, and STI history as key determinants. HCV seroprevalence remained low (< 0.4%) and was highest among non-Western migrants. HIV prevalence was 0.1% and highest among non-Western migrants and men who have sex with men. Only 9% of active HBV cases were aware of their status. Overall, HBV, HCV, and HIV seroprevalence remain low in the Netherlands but are concentrated in specific groups with limited awareness. These findings support targeted prevention, screening, and linkage-to-care strategies to achieve the 2030 WHO elimination goals and highlight the importance of continued population-based (sero-)monitoring to guide public health policy.
Interferon-free direct-acting antivirals (DAAs), which are highly effective in eliminating hepatitis C virus (HCV), became available in Japan in 2014. This study aimed to estimate the nationwide socioeconomic outcomes of DAA therapy in Japan using publicly available records, including data from the hepatitis subsidy program and universal healthcare claims between fiscal years 2014 and 2023. Based on the standard dose of each DAA regimen, approximately 300,000 people were estimated to have been treated with DAA therapy by 2023, with a cumulative drug cost of at least 1.23 trillion Japanese yen (10.8 billion United States dollars). The main indication for DAA therapy was the initial treatment of chronic HCV infection without cirrhosis. The estimated cost and number of treated people peaked in 2015, followed by a declining trend. For most DAA regimens, annual prescriptions were the greatest in the same or the following year of approval. Sofosbuvir/ledipasvir and glecaprevir/pibrentasvir were the two most common regimens. The age of people treated with DAA therapy shifted towards younger people during the survey period, particularly in males. While the estimated prevalence of people treated with DAA therapy was higher in Western Japan, the estimated number of treated people and population in each prefecture showed a linear association (p < 0.001). Despite the large economic impact, the rapid uptake of DAA therapy suggests an active program of case finding and treatment with the goal of HCV elimination in Japan. Whereas the demographics of people receiving DAA therapy changed over time, treatments were provided uniformly across the nation.
Low-level residual viremia can be present in chronic hepatitis B (CHB) patients on nucleos(t)ide analogues (NUCs). Due to the detection limits of current HBV DNA assays, the association between residual viremia and HBV-related HCC has not been well studied. This study included NUC-treated HBV-related HCC patients with unquantifiable serum HBV DNA by the conventional Cobas-Taqman assay (< 20 IU/mL) at HCC diagnosis. The HCC patients were matched in a 1:1 ratio with NUC-treated non-HCC controls. Serum samples at the time of HCC diagnosis, 1 year before, and 2 years before diagnosis were retrospectively retrieved and tested for residual viremia by a validated high-sensitivity droplet digital polymerase chain reaction assay (lower limit of detection 1.6 IU/mL). Among 208 patients (104 HCC vs. 104 controls; mean age 63.1, 80.8% male, 54.3% cirrhosis), residual viremia within 2 years was observed in 82.7% of HCC patients and 49.0% of controls (p < 0.001), and was independently associated with HCC occurrence (OR 7.243, 95% CI 1.862-28.170, p = 0.004). In HCC patients, residual viremia was associated with histological microvascular invasion (44.4% vs. 9.1% in patients without residual viremia, p = 0.033) and lower probability of presenting with Barcelona Clinic Liver Cancer stage 0 HCC (OR 0.281, 95% CI 0.094-0.838, p = 0.023). After median follow-up for 7.2 years, residual viremia within 2 years before HCC diagnosis was independently associated with liver-related mortality (HR 4.472, 95% CI 1.212-16.504, p = 0.025). Residual viremia in NUC-treated CHB patients is associated with a higher risk of HCC development, more advanced tumour staging and poorer outcomes. High-sensitivity HBV DNA assays may be utilized for monitoring in NUC treatment.
To achieve hepatitis B virus (HBV) elimination in Australia, a shift from hospital to community-based care is needed. This study aimed to describe the prevalence of chronic HBV and uptake of the cascade of care in primary care patients. This prospective cohort study was conducted in 76 urban and regional primary care clinics across Victoria, Australia between 1/7/2020 and 30/6/2023. Anonymised socio-demographic, clinical and laboratory data from general practice (GP) clinics' electronic medical records (EMR) were extracted. Descriptive analysis of the cohort of clinic clients with HBV was performed. A total of 346,927 individuals attended appointments across the study period. Of these, 25,212 had records indicating HBV-related testing. 491 (0.14%) individuals had evidence of current HBV infection defined as HBV surface antigen (HBsAg) positive and/or HBV DNA positive. 469 attended the clinics during the study period, among whom 239 (51%) were female. In the GP EMR, only 59 (13%) had evidence of at least one HBV DNA test and at least one ALT test ordered. Fourteen patients (3%) had record of being reviewed for HBV management by the clinic nurse or GP and 78 (17%) reviewed by a viral hepatitis specialist. Ninety-two (20%) were on treatment for HBV. Of people receiving treatment, 23 (25%) had a record of linkage to specialist care. Our data show that significant gaps in the cascade of care remain for people with chronic HBV in primary care settings, with a low proportion of patients having evidence of participating in all stages of the HBV cascade of care.
Daily subcutaneous bulevirtide (BLV) 2 mg has been approved as first-line treatment for chronic hepatitis D (CHD), but long-term real-world adherence data are limited. We assessed adherence rates during BLV therapy and their impact on treatment response. HERACLIS_BLV_D study (NCT05928000) included adult CHD patients initiating BLV 2 mg/day and followed in routine clinical practice. Virological response (VR) was defined as HDV RNA < 57.5 IU/mL or decline > 2 log10 and biochemical response (BR) as normal ALT (≤ 40 IU/L). Adherence was evaluated through the national prescription system based on executed monthly BLV prescriptions. Treatment discontinuation was defined as no executed BLV prescription for > 3 months at the end of follow-up. Seventy-six patients were included. VR/BR rates were 73%/71% at 12 and 93%/74% at 24 months. Thirteen (17%) patients discontinued BLV (none due to adverse events); 6%-7% per year. Mean adherence among treated patients was 98% ± 6% in 1st year declining to 93% ± 13% in 2nd and 91% ± 17% in 3rd year (p ≤ 0.010). No baseline characteristic was associated with poor (< 90%) or good (≥ 90%) adherence to BLV therapy. Patients with poor vs. good adherence had lower VR rates (1st year: 33% vs. 77%, p = 0.038; 2nd year: 60% vs. 97%, p = 0.030). In conclusion, in clinical practice, < 10% of CHD patients discontinue BLV therapy annually. Adherence is excellent in the first year and remains > 90% until the third year although gradually declines. Poor (< 90%) adherence cannot be predicted but adversely affects the VR rates emphasizing the need for strategies to support long-term treatment retention.
The current two-step model for HCV diagnosis risks losing people from care; a one-step diagnostic approach could improve retention. We investigated whether shortening the read time of an HCV antibody test from 20-min to 1 or 5-min could accurately predict HCV RNA viremia in-lieu of a standard RNA test. 1110 people in Yangon had a HCV Ab using Bioline HCV RDT. Results were recorded at 1-min intervals until 20-min, with HCV RNA testing of reactive results at 20-min. 884 participants returned both antibody and RNA results; 838 were Ab reactive at 1-min, 875 were reactive at 5-min and 728 were RNA positive. Sensitivity was 98.6% and 100% for 1 and 5-min read-times, and specificity was 23.1% and 5.8% for 1 and 5-min respectively. Our results suggest that reading the Bioline at 5 min has potential to identify patients with HCV infection ahead of reflexive RNA testing. Trial Registration: ClinicalTrials.gov:NCT03939013.
We evaluated cardiac extracellular volume (ECV) fraction, a sign of inflammation and fibrosis, in 10 individuals with chronic Hepatitis C virus (HCV) infection prior to treatment using cardiac magnetic resonance (CMR) at 3 T. Compared to age-matched, healthy volunteers, HCV-infected individuals had significantly increased ECV fraction (0.30 ± 0.03 vs. 0.26 ± 0.03, p = 0.0036) regardless of myocardial damage markers, hypertension as a comorbidity, smoking pack-years or fibrosis stage. Our results show that untreated hepatitis C is associated with the development of extrahepatic manifestations even before the onset of liver fibrosis, highlighting that early HCV treatment is prudent to reduce all-cause morbidity.
People who use drugs (PWUD) have a disproportionately elevated risk of hepatitis C virus (HCV). Appropriate screening and treatment may be limited, especially in rural environments experiencing healthcare shortages. In order to develop targeted intervention strategies for rural PWUD, we investigated individual and network-level correlates of HCV positivity. Survey data were collected from PWUD from the Illinois region of the Federal Delta Regional Authority (DRA). The primary outcome of interest was HCV positivity by self-report. We explored associations between HCV positivity and individual demographic, drug use, and service utilisation characteristics as well as degree of connectedness within social networks. Three hundred and two participants were included in analyses. At the individual level, HCV positivity was associated with injection drug use, overdose history, and prior receipt of substance use treatment. Two hundred and one participants had at least one connection to a peer via referral chains, most of which contained a mix of HCV-negative and positive individuals. Of note, isolated individuals had comparable rates of HCV positivity compared to their socially connected peers. Degree of connectedness was not associated with HCV positivity. This study highlights the heterogeneity, both with respect to HCV positivity and other characteristics, among networks of rural PWUD. Given that most participants were connected to others, HCV interventions led by peer champions may facilitate improved access to critical services for risk mitigation.
The epidemiological landscape of paired hepatitis B virus (HBV)/hepatitis delta virus (HDV) genotype (GT) among patients with HDV in the US remains unknown. HBV/HDV genotypes were assessed in two independent US cohorts: Cohort 1 included 5222 HBV-positive patients from Quest Diagnostics, including 114 anti-HDV+ patients; Cohort 2 included 178 anti-HDV+ samples from highly phenotyped patients managed at the National Institutes of Health (NIH). HBV/HDV sequencing and genotyping were analysed using phylogenetic analyses. In the overall cohort, HBV and HDV genotypes were determined for 197 (67%) and 139 (48%) patients, respectively, with HDV GT1 and GT5 and paired HBV/HDV genotypes D/1 and A/1 being the most prevalent. The most frequent HBV genotypes were GTD (40%) and GTA (35%), and the most frequent HDV genotypes were GT1 (84%) and GT5 (13%). Among 111 paired HBV/HDV genotypes, D/1 (50%) and A/1 (26%) were most common. In Cohort 2, 77 (79%) patients with HDV GT1 were foreign-born, most commonly Mongolian-born (47/77, 61%), while 21% (20/77) were US-born. Among patients with HDV GT5, GT6, or GT7, 93% (14/15) were of African origin. Overall, these findings provide the first comprehensive US analysis of HBV/HDV paired genotypes among patients with HDV and indicate that HBV genotype distributions differ between HBV/HDV coinfection and HBV monoinfection.
People who have been detained have a higher prevalence of hepatitis B virus (HBV) than the general population, yet testing uptake remains limited. Improving testing uptake in high-risk settings is essential to the World Health Organization 2030 elimination target. This systematic review examines interventions aimed at increasing hepatitis B testing uptake in prison. MEDLINE, EMBASE, CENTRAL and CINAHL were searched from January 2000 to April 2025. Quantitative interventional studies were included. Quality appraisal was conducted using the JBI critical appraisal tool. A random effects meta-analysis with Freeman-Tukey transformation estimated testing uptake. Subgroup analysis explored heterogeneity by sex, geographical region and the screening approach. Sixteen papers (15 studies) were included. Eleven were post-interventional quasi-experimental studies. Nine were conducted in Europe. The pooled testing uptake was 64% (95% CI 46%-80%; I2 = 98%). Opt-in interventions were associated with a higher testing uptake (77%, 95% CI 59%-91%), in comparison to opt-out testing uptake (33%, 95% CI 17%-52%; p < 0.001), although opt-in screening had enhanced characteristics such as counselling, peer education and culturally tailored approaches. HBV prevalence amongst institutions ranged between 0% and 11.4%. Only one study reports costs. Opt-in programmes were associated with a higher testing uptake in comparison to opt-out programmes, which may reflect the underlying programme characteristics rather than the screening approach alone. Evidence on cost-effectiveness is limited. Most studies were heterogeneous and conducted in high-income countries. Further robust studies are needed to evaluate enhanced screening approaches to determine the most effective and scalable screening programme.
