Table of contents

Hepatitis D virus infection

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Updated 2024 WHO guidelines for the diagnosis and management of 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 World Health Organization (WHO 2024), 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 ...
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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.
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Diagnostic investigations

Indications for testing: as per WHO 2024 guidelines, consider obtaining serological testing for anti-HDV antibodies as the preferred approach to scale up access to HDV diagnosis and linkage to care in all HBsAg-positive patients.
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  • Laboratory testing

  • Noninvasive assessment

Diagnostic procedures

Liver biopsy: as per EASL 2023 guidelines, perform liver biopsy for grading and staging liver disease without clinical or imaging signs of cirrhosis or if it May alter management.

Medical management

Setting of care: as per AASLD 2018 guidelines, consider referring patients with HDV infection to specialized centers offering access to experimental therapies for HDV infection given the limited efficacy of current therapies.

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  • Indications for treatment

  • Pegylated interferon

  • Bulevirtide

  • Nucleoside/nucleotide analogs

Surgical interventions

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

Pregnant patients
As per EASL 2023 guidelines:
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.
Do not discourage breastfeeding in infants born to mothers with HBV/HDV coinfection, as it is safe.

Follow-up and surveillance

Serial clinical assessment
As per EASL 2023 guidelines:
Monitor for the development of liver-related clinical events during and after treatment in patients with chronic HDV infection.
Obtain regular work-up for liver disease at least every 6-12 months in patients with chronic HDV infection.

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  • Serial virological assessment

  • Serial biochemical assessment

  • Serial imaging assessment

  • Serial histological assessment