Recommendations for the integral diagnosis of chronic viral hepatitis in a single analytical extraction

Comprehensive Diagnosis of Viral Hepatitis in Spain: Bases for Implementation

In 2022, scientific societies agreed on a document with recommendations for a comprehensive diagnosis of viral hepatitis (B, C, and D). The aim was to evaluate the situation in Spain regarding the comprehensive diagnosis of viral hepatitis in a single blood draw before it is recommended. A panel of experts prepared a structured survey directed at hospitals (public or private with teaching accreditation) with ≥200 beds (sent 20 October 2022, closed 1 December 2022). The response rate was 61% (79/129; 52 hospitals with >500 beds). Among the participating hospitals, all could perform tests for HBsAg, anti-HCV, and HIV serology; 94% could perform PCR testing for HCV, 63% could test for anti-HDV, and 28% could test for HDV-RNA (67% [53/79] outsourced this testing). Point-of-care (POC) testing availability was low (24%), with 84% of these tests being supervised by the reference microbiological laboratory and the results being registered in the patients' medical history. Ninety percent of the centers carried out the diagnosis in a single step (99% HCV, 70% HBV, 48% HDV, and 44% HBV-HDV). In addition, 77% used some communication strategy when an active infection was encountered (100% HCV, 49% HBV, and 31% HDV). Only 20% had an automated system for scheduling a specialist physician appointment. Most hospitals had the means for a comprehensive diagnosis of viral hepatitis in a single sample, but <50% could test for HBV/HDV. Alerts for continuity of care were available for HCV, but not HBV or HDV. POC device implementation is important for decentralized testing.

Double reflex testing improves the efficacy and cost effectiveness of hepatitis delta diagnosis in southern Spain

This study aims to evaluate the prevalence of undiagnosed hepatitis delta in southern Spain (Andalusia) and assess the effectiveness and cost-efficiency of implementing reflex testing for hepatitis D detection in HBsAg-positive patients. A multicenter ambispective study was conducted in 17 Andalusian hospitals. The retrospective phase (January 2018-June 2022) analyzed diagnostic processes for hepatitis delta in HBsAg-positive patients. The prospective phase (October 2022-March 2023) implemented reflex testing, performing anti-HDV serology on all HBsAg-positive patients without prior testing. HDV RNA testing followed for those who tested anti-HDV-positive. In the retrospective phase, out of 18,583 HBsAg-positive patients, anti-HDV tests were performed on 3,436 (18%), identifying 205 (6%) positive cases. HDV RNA was tested in 158 (77%) anti-HDV-positive patients, with 69 (44%) testing positive. In the prospective phase, out of 2,384 HBsAg-positive patients without prior anti-HDV testing, 2,293 (96%) were tested, identifying 109 (4.7%) positive cases. HDV RNA was analyzed in 97 (89%) anti-HDV-positive patients, with 30 (31%) testing positive. Reflex testing increased anti-HDV detection by 77%, resulting in a fourfold increase in detecting anti-HDV-positive patients and a threefold increase in detecting HDV RNA-positive patients, reducing undiagnosed HDV RNA-positive cases to 4% compared to 45% with clinical practice. Cost analysis indicated a saving of €265,954 with reflex testing. Reflex testing improves HDV detection, reduces costs, and simplifies diagnosis, making it an efficient strategy for managing chronic hepatitis D patients.

Cost analysis of hidden hepatitis D virus infection in Spain

INTRODUCTION

A significant percentage of patients coinfected with hepatitis B virus (HBV) and hepatitis D virus (HDV) are undiagnosed. Coinfected patients progress to advanced liver disease faster than HBV monoinfected patients, thereby consuming more healthcare resources. The aim was to perform an analysis to determine the cost of hidden HDV infection in Spain.

METHODS

An analytical model was developed to estimate the prevalence of hidden HDV infection with/without advanced liver disease at the time of diagnosis. An epidemiological flow chart was established to quantify undiagnosed chronic hepatitis D patients. The percentages of patients with compensated cirrhosis (CC), decompensated cirrhosis (DC), hepatocellular carcinoma (HCC) and requiring liver transplantation (LT) and their annual costs were subsequently obtained from the literature. Direct healthcare costs were considered within a time horizon of 1 year. For patients without advanced disease, the consumption of healthcare resources was obtained from an experts panel.

RESULTS

A total of 2180 patients with hidden HDV infection were estimated; of these, 1188 (54%) had advanced liver disease (29%-CC, 57%-DC, and 8%-HCC) or underwent LT (6%), and 992 (46%) patients did not have advanced disease. The total annual cost of hidden HDV would be € 17.8million (€ 16.9million with advanced disease and € 882,400 for those without).

CONCLUSIONS

Hidden HDV infection represents a high economic burden in Spain due to the rapid progression of liver disease in affected patients. These results highlight the importance of early diagnosis to prevent future clinical and economic burden related to liver disease progression.

[Strategy for early detection of viral hepatitis in patients with a request for liver biochemistry profile and hypertransaminasemia]

OBJECTIVE

Undiagnosed viral hepatitis is an impediment to the elimination of viral hepatitis. Clinical Practice Guidelines (CPG) recommend screening in patients with hypertransaminasemia. The aim of the study was to evaluate the early detection of viral hepatitisB andC established in our health area in this population group.

METHODS

Prospective observational study over a period of 28months (February 2021-May 2023) of all patients with a request for a liver biochemical profile in whom hypertransaminasemia was detected and who met the inclusion criteria for early detection of viral hepatitis. In these patients, a one-step comprehensive diagnosis of viral hepatitis was performed. A preferential care circuit was established for the selected patients with active infection with a specialist in hepatology for linkage, evaluation and prescription, if appropriate, of antiviral treatment.

RESULTS

Of the 2,058 patients selected, 148 patients (7.2%) tested positive for previously undiagnosed viral infection: 121 for hepatitisB virus (HBV) and 27 for hepatitisC virus (HCV). Of the 11 patients with chronic HBV infection, 10 had active HBV infection, of whom 3 had treatment indications. Of the patients with positive HCV serology, 77.8% were viremic and all were treated with sustained viral response (SVR).

CONCLUSIONS

Implementation of this strategy has identified and treated an appreciable number of undiagnosed HBV and HCV infections with impact at the individual and community level.

Hepatitis B Delta: assessment of the knowledge and practices of hepato-gastroenterologists practicing in non-academic settings in France

BACKGROUND

Data on the management of Hepatitis B-Delta (HB-D) by hepatogastroenterologists (HGs) practicing in nonacademic hospitals or private practices are unknown in France.

OBJECTIVE

We aimed to evaluate the knowledge and practices of HGs practicing in nonacademic settings regarding HB-D.

METHODS

A Google form document was sent to those HGs from May to September 2021.

RESULTS

A total of 130 HGs (mean age, 45 years) have participated in this survey. Among HBsAg-positive patients, Delta infection was sought in only 89% of cases. Liver fibrosis was assessed using FibroScan in 77% of the cases and by liver biopsy in 81% of the cases. A treatment was proposed for patients with >F2 liver fibrosis in 49% of the cases regardless of transaminase levels and for all the patients by 39% of HGs. Responding HGs proposed a treatment using pegylated interferon in 50% of cases, bulevirtide in 45% of cases and a combination of pegylated interferon and bulevirtide in 40.5% of cases. Among the criteria to evaluate the treatment efficacy, a decrease or a normalization of transaminases was retained by 89% of responding HGs, a reduction of liver fibrosis score for 70% of them, an undetectable delta RNA and HBsAg for 55% of them and a 2 log 10 decline in delta viremia for 62% of the cases.

CONCLUSION

Hepatitis Delta screening was not systematically performed in HBsAg-positive patients despite the probable awareness and knowledge of the few responders who were able to prescribe treatments of hepatitis delta.