Abstract：
Current US guidelines recommend risk-based testing for hepatitis delta virus (HDV) in persons with chronic hepatitis B (CHB). While there is debate as to whether a risk-based or universal testing approach is most effective, limited data exist on universal HDV testing programs in the United States. We performed a 1-year pilot study evaluating the outcomes of a universal HDV testing approach among US veterans with CHB. All consecutive adults with CHB receiving care at hepatology clinics at a single-centre Veterans Affairs Health System from 1 October 2022 to 30 September 2023 were prospectively tested for anti-HDV antibody (anti-HDV). Patients who were anti-HDV Ab-positive were subsequently tested for HDV RNA. Comparison of HDV testing between groups utilised chi-square testing. A total of 91 consecutive CHB patients (90.0% male, mean age 60.9 ± 14.1 years, 73.9% Asian, 26.1% non-Asia, 16.5% cirrhosis and 17.1% with active or past history of drug use) had anti-HDV ordered. Overall, 76.9% (n = 70) completed anti-HDV testing; 4.3% (n = 3) were positive. HDV RNA testing was ordered in all three patients; two patients completed HDV RNA testing and one had detectable HDV RNA. No significant differences in completion of anti-HDV testing was observed by age, sex, race/ethnicity, cirrhosis status or drug use history. Among a single-centre prospective cohort study piloting a universal HDV testing approach, one patient with viremic HDV was identified. Implementing true reflex testing of all CHB patients with anti-HDV, followed by automated HDV RNA testing for anti-HDV-positive patients would improve the HDV testing cascade and timely diagnosis of HDV.
摘要：
目前的美国指南建议对慢性乙型肝炎（CHB）患者进行丁型肝炎病毒（HDV）的风险检测。虽然关于基于风险的测试方法或通用测试方法是否最有效存在争议，在美国，通用HDV测试程序的数据有限。我们进行了一项为期1年的试点研究，评估了美国退伍军人CHB中通用HDV测试方法的结果。从2022年10月1日至2023年9月30日，在单中心退伍军人事务卫生系统的肝病诊所接受治疗的所有CHB连续成年人都进行了抗HDV抗体（抗HDV）的前瞻性测试。随后测试抗HDVAb阳性的患者的HDVRNA。组间HDV检验的比较采用卡方检验。共有91例CHB患者（90.0%为男性，平均年龄60.9±14.1岁，73.9%亚洲人，26.1%非亚洲，16.5％的肝硬化和17.1％的积极或过去的药物使用史）有抗HDV订购。总的来说,76.9％（n=70）完成了抗HDV测试；4.3％（n=3）为阳性。在所有三名患者中都进行了HDVRNA测试;两名患者完成了HDVRNA测试，其中一名具有可检测的HDVRNA。在完成抗HDV测试方面没有观察到年龄的显著差异，性别,种族/民族,肝硬化状态或药物使用史。在一项单中心前瞻性队列研究中，试行了一种通用的HDV测试方法，发现1例HDV病毒血症患者.实施真正的反射测试所有CHB患者与抗HDV，其次是抗HDV阳性患者的自动化HDVRNA检测将改善HDV检测级联和及时诊断HDV。
