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Hepatitis D virus infection

Key sources
The following summarized guidelines for the evaluation and management of hepatitis D virus infection are prepared by our editorial team based on guidelines from the European Association for the Study of the Liver (EASL 2023; 2017; 2016), the Kidney Disease: Improving Global Outcomes Foundation (KDIGO 2020), and the American Association for the Study of Liver Diseases (AASLD 2018).
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Guidelines

1.Screening and diagnosis

Indications for screening: as per KDIGO 2020 guidelines, obtain screening for HDV infection with HDV serology in HBsAg-positive or HBcAb-positive patients from HDV endemic areas.
B
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2.Diagnostic investigations

Indications for testing: obtain evaluation for active HDV infection in patients with HBV infection and deteriorating liver function despite anti-HBV therapy.
B

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  • Laboratory testing

  • Noninvasive assessment

3.Diagnostic procedures

Liver biopsy: perform liver biopsy for grading and staging liver disease without clinical or imaging signs of cirrhosis or if it may alter management.
B

4.Medical management

Setting of care: consider referring patients with HDV infection to specialized centers offering access to experimental therapies for HDV infection given the limited efficacy of current therapies.
E

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  • Indications for treatment

  • Pegylated interferon

  • Bulevirtide

  • Nucleoside/nucleotide analogs

5.Surgical interventions

Liver transplantation: as per EASL 2023 guidelines, evaluate patients with decompensated cirrhosis for liver transplantation.
B
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6.Specific circumstances

Pregnant patients
Offer the same management of delivery in pregnant patients with HBV/HDV coinfection as in patients with HBV since HDV mother-to-child transmission is rare and prevention of HBV infection is effective at preventing hepatitis D infection.
B
Do not discourage breastfeeding in infants born to mothers with HBV/HDV coinfection, as it is safe.
D

7.Follow-up and surveillance

Serial clinical assessment
Monitor for the development of liver-related clinical events during and after treatment in patients with chronic HDV infection.
B
Obtain regular work-up for liver disease at least every 6-12 months in patients with chronic HDV infection.
B

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  • Serial virological assessment

  • Serial biochemical assessment

  • Serial imaging assessment

  • Serial histological assessment