1Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
2Gastroenterology and Hepatology, NYU Langone Health, NYU Grossman School of Medicine, New York, USA.
3Robert G. Gish Consultants, LLC, 6022 La Jolla Mesa Dr, La Jolla, CA, 92037-7814, USA.
4Medical Director Hepatitis B Foundation, Doylestown, PA, USA.
5NYU Langone Gastroenterology Associates, 240 East 38Th Street, 23Rd Floor, New York, NY, 10016, USA.
6University of California, Irvine, 101 The City Dr S, Building 22C, Room 1503, Orange, CA, 92868, USA.
7Clinic for Gastroenterology, Hepatology and Endocrinology Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
8University of Miami Miller School of Medicine, 1500 NW 12 AVE., E Tower #1101, Miami, FL, 33136, USA. Pmartin2@med.miami.edu.
Hepatitis D virus (HDV) depends on hepatitis B virus (HBV) to enter and exit hepatocytes and to replicate. Despite this dependency, HDV can cause severe liver disease. HDV accelerates liver fibrosis, increases the risk of hepatocellular carcinoma, and hastens hepatic decompensation compared to chronic HBV monoinfection. The Chronic Liver Disease Foundation (CLDF) formed an expert panel to publish updated guidelines on the testing, diagnosis, and management of hepatitis delta virus. The panel group performed network data review on the transmission, epidemiology, natural history, and disease sequelae of acute and chronic HDV infection. Based on current available evidence, we provide recommendations for screening, testing, diagnosis, and treatment of hepatitis D infection and review upcoming novel agents that may expand treatment options. The CLDF recommends universal HDV screening for all patients who are Hepatitis B surface antigen-positive. Initial screening should be with an assay to detect antibodies generated against HDV (anti-HDV). Patients who are positive for anti-HDV IgG antibodies should then undergo quantitative HDV RNA testing. We also provide an algorithm that describes CLDF recommendations on the screening, diagnosis, testing, and initial management of Hepatitis D infection.