Implementation of anti-HDV reflex testing among HBsAg-positive individuals increases testing for hepatitis D.
Implementation of anti-HDV reflex testing among HBsAg-positive individuals increases testing for hepatitis D.
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DOI：
10.1016/j.jhepr.2022.100547
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发表时间：
2022-10
期刊：
影响因子：
8.3
通讯作者：
Buti, Maria
中科院分区：
文献类型：
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作者：
Palom, Adriana;Rando-Segura, Ariadna;Vico, Judit;Pacin, Beatriz;Vargas, Elena;Barreira-Diaz, Ana;Rodriguez-Frias, Francisco;Riveiro-Barciela, Mar;Esteban, Rafael;Buti, Maria
尽管EASL指南建议在所有HBsAg阳性个体中进行抗HDV检测，但HDV感染仍然是一种未被诊断的疾病。我们描述了反射抗HDV测试在所有HBsAg阳性样本的HDV筛查计划的影响，并比较其实施前后的结果。从2018年1月至2021年12月，共纳入了2，236份HBsAg阳性测定结果。仅对每位参与者的第一个样本进行了评估：反射抗HDV测试前（2018-2020年）有1，492个样本，反射抗HDV测试后（2021年）有744个样本。收集抗HDV阳性患者的人口统计学和临床特征。在反射测试之前，在7.6%（114/1492）的HBsAg阳性个体中进行了抗HDV测试：23%（91/390）在学术医院就诊，只有2%（23/1,102）在初级保健中心就诊。在建立反射试验后，93%（691/744）的HBsAg阳性病例进行了抗HDV评价：91%（533/586）在学术医院和100%（158/158）在初级保健。反射试验前后抗HDV阳性率相似：分别为9.6%（11/114）和8.1%（56/691）。然而，抗HDV阳性患者的绝对数量增加。大多数抗HDV阳性患者为年轻、HBeAg阴性的白人男性。HDV-RNA在35（65%）检测54，HBV-DNA是不可检测的64%，丙氨酸氨基转移酶水平是正常的48%。抗HDV反射检测使慢性丁型肝炎感染的绝对诊断数增加了五倍。在反射试验之前，很大比例的HBsAg阳性个体没有进行任何抗HDV测定。反射试验的实施增加了慢性丁型肝炎患者的诊断。慢性丁型肝炎（CHD）是一种由HDV引起的病毒性疾病，需要HBV的存在才能传播。HDV感染可导致迅速进展为肝硬化，以及其他严重并发症。冠心病在全球的流行是有争议的，感染往往不被承认，主要是因为医生的不了解。在其他病毒性肝炎中使用反射测试已被证明可以增加感染患者的检测和护理联系。对所有HBsAg阳性患者进行抗丁型肝炎病毒检测，使一家学术医院和初级保健中心的丁型肝炎病毒诊断数增加了5倍。尽管EASL指南建议进行普遍筛查，但日常临床实践中的HDV检测率很低。HDV反射检测的实施导致诊断为丁型肝炎的HBV病例数增加了5倍。在60%的抗HDV阳性病例中，风险因素未知，支持在所有HBsAg阳性患者中进行系统的抗HDV反射测试。因此，评价抗HDV反射试验的成本效益具有重要价值。
Although EASL guidelines recommend anti-HDV testing in all HBsAg-positive individuals, HDV infection remains an underdiagnosed condition. We describe the impact of an HDV screening program by reflex anti-HDV testing in all HBsAg-positive samples and compare the results before and after its implementation. In total, 2,236 HBsAg-positive determinations were included from January 2018 to December 2021. Only the first sample from each participant was evaluated: 1,492 samples before reflex anti-HDV testing (2018–2020) and 744 samples after (2021). Demographic and clinical characteristics of anti-HDV-positive patients were collected. Before reflex testing, anti-HDV had been tested in 7.6% (114/1492) of HBsAg-positive individuals: 23% (91/390) attended in an academic hospital and only 2% (23/1,102) in primary care centres. After reflex testing was established, 93% (691/744) of HBsAg-positive cases were evaluated for anti-HDV: 91% (533/586) in the academic hospital and 100% (158/158) in primary care. The anti-HDV-positive prevalence was similar before and after reflex testing: 9.6% (11/114) and 8.1% (56/691), respectively. However, the absolute number of anti-HDV-positive patients increased. Most anti-HDV-positive patients were young, HBeAg-negative, Caucasian males. HDV-RNA was detectable in 35 (65%) of 54 tested, HBV-DNA was undetectable in 64%, and alanine aminotransferase levels were normal in 48%. Anti-HDV reflex testing quintupled the absolute number of diagnoses of chronic hepatitis D infection. Before the reflex test, a large percentage of HBsAg-positive individuals had not undergone any anti-HDV determination. Implementation of reflex testing increases the diagnosis of patients with chronic hepatitis D. Chronic hepatitis delta (CHD) is a viral disease caused by HDV, which requires the presence of HBV to propagate. HDV infection can cause rapid progression to cirrhosis, among other severe complications. The prevalence of CHD worldwide is controversial, and the infection often goes unrecognised, mainly because of unawareness among physicians. Use of reflex testing in other viral hepatitis has proven to increase detection and linking-to-care of infected patients. Implementation of anti-HDV testing in all HBsAg-positive patients has led to a 5-fold increase in the number of HDV diagnoses in an academic hospital and primary care centres. HDV testing rates in daily clinical practice are low despite EASL guidelines recommending universal screening. Implementation of HDV reflex testing led to a 5-fold increase in the number of HBV cases diagnosed with hepatitis D. Risk factors were unknown in 60% of anti-HDV positive cases, supporting systematic anti-HDV reflex testing in all HBsAg-positive patients. It would be of great value to assess the cost-effectiveness of anti-HDV reflex testing.
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影响因子：
6.6
作者：
Sarin SK;Kumar M;Lau GK;Abbas Z;Chan HL;Chen CJ;Chen DS;Chen HL;Chen PJ;Chien RN;Dokmeci AK;Gane E;Hou JL;Jafri W;Jia J;Kim JH;Lai CL;Lee HC;Lim SG;Liu CJ;Locarnini S;Al Mahtab M;Mohamed R;Omata M;Park J;Piratvisuth T;Sharma BC;Sollano J;Wang FS;Wei L;Yuen MF;Zheng SS;Kao JH
通讯作者：
Kao JH
DOI：
10.1097/meg.0000000000000795
发表时间：
2017-03-01
影响因子：
2.1
作者：
Ordieres, Carlos;Navascues, Carmen A.;Rodriguez, Manuel
通讯作者：
Rodriguez, Manuel
影响因子：
7.5
作者：
Stroffolini, Tommaso;Sagnelli, Evangelista;Almasio, Piero Luigi
通讯作者：
Almasio, Piero Luigi
影响因子：
25.7
作者：
通讯作者：
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影响因子：
25.7
作者：
通讯作者：
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