Quest: US Hepatitis Delta Burden

Quest Diagnostics Inc., Secaucus, NJ investigated the prevalence of Hepatitis Delta Virus (HDV) infection in the United States among individuals already infected with Hepatitis B Virus (HBV), utilizing a nationwide sample of remnant specimens.  They found an overall HDV antibody seroprevalence of 2.2% among Hepatitis B surface antigen (HBsAg) positive specimens across the United States.  This prevalence is lower than some previously reported estimates from more limited studies or those focusing on high-risk populations. The authors suggest this difference may reflect the success of HBV vaccination programs in reducing the overall pool of HBsAg-positive individuals and, consequently, HDV infections.  Regional seroprevalence rates were not significantly different, although the highest proportions were observed in Regions 8 (4.1%) and 5 (2.9%). The highest absolute number of HDV Ab-positive specimens (n=24) was found in Region 9 (California, Nevada, Arizona).  The study's approach, utilizing a population-level sample of remnant specimens proportional to regional population sizes, provides a comprehensive overview not influenced by clinician testing biases.

The study highlights the significant underutilization of HDV testing in the United States, despite HDV infection being a severe complication of HBV; it is is the most severe form of viral hepatitis and is associated with more severe liver disease, including a higher risk of cirrhosis and hepatocellular carcinoma (HCC).  Identifying HDV-infected individuals is crucial for appropriate monitoring and management, especially with the emergence of promising new therapeutics.  Patients with HDV require closer monitoring and earlier surveillance for HCC. Their direct contacts who are HBV positive should also be tested for HDV.

Marlowe EM, Swanson BE, Realegeno SE, Meyer WA 3rd, Gish R, Kagan RM. Epidemiological Burden of Hepatitis Delta Virus in the United States. J Viral Hepat. 2025 Jun;32(6):e70029. doi: 10.1111/jvh.70029. PMID: 40298139.

https://onlinelibrary.wiley.com/doi/10.1111/jvh.70029