Hepatitis D Virus Status Among People With Hepatitis B Virus Infection: A Disconnect Between Guidelines and Practice

Abstract

Background: Hepatitis D virus (HDV) infection is an important cause of chronic liver disease yet remains a poorly met clinical challenge. The current European and UK guidelines recommend that all patients with hepatitis B virus (HBV) are tested for HDV, but emerging UK data indicates that only approximately 20% have been tested. The World Health Organization viral hepatitis elimination strategy first requires the systematic testing of people with relevant risk factors, so there is a need to understand factors contributing to low anti-HDV rates of testing.

Methods: An audit was conducted to ascertain the perspectives of patients and healthcare professionals about identifying HDV infection. During a 4-month period, 39 hepatology healthcare professionals and 70 patients with chronic HBV were recruited. The attitudes of healthcare professionals about HDV testing were surveyed according to the seven constructs of the theoretical framework of acceptability (TFA). Patients were surveyed by telephone about their knowledge of HDV and their own testing status.

Results: Among the 39 healthcare professionals, only 66.6% and 53.8% were able to correctly cite EASL (European) HDV and NICE (UK) testing guidelines, respectively, although there were high levels of anti-HDV testing acceptability according to the TFA. Among the patients, 95.7% (67/70) had been tested for anti-HDV and all were seronegative. Only 23% (16/70) knew of the existence of HDV. There was extensive ethnic heterogeneity with 23 countries of birth and 24 different primary languages.

Conclusion: Some clinicians lack familiarity with clinical guideline recommendations for universal testing of all HBsAg-positive patients. Similarly, most patients lack knowledge about HDV. Staff and patient education are required to increase HDV diagnosis.