title: Hepatitis delta virus testing, epidemiology and management: a multicentre cross-sectional study of patients in London.
abstract: BACKGROUND
  Hepatitis delta virus (HDV) testing is recommended for all patients with hepatitis B virus (HBV) infection. HDV infection is associated with severe liver disease and interferon is the only available treatment.
  
  
  OBJECTIVE
  To determine the rate of anti-HDV antibody testing in HBV patients; and to describe the epidemiology, clinical characteristics and management of HDV-infected patients at four hospitals in London.
  
  
  METHODS
  The anti-HDV testing rate was estimated by reviewing clinical and laboratory data. Cross-sectional data collection identified HDV-infected patients who had attended the study centres between 2005 and 2012.
  
  
  RESULTS
  At a centre with clinic-led anti-HDV testing, 40% (67/168) of HBV patients were tested. Recently diagnosed HBV patients were more likely to be screened than those under long-term follow-up (62% vs 36%, P=0.01). At a centre with reflex laboratory testing, 99.4% (3543/3563) of first hepatitis B surface antigen positive samples were tested for anti-HDV. Across the four study centres there were 55 HDV-infected patients, of whom 50 (91%) had immigrated to the UK and 27 (49%) had evidence of cirrhosis. 31 patients received interferon therapy for HDV with an end of treatment virological response observed in 10 (32%).
  
  
  CONCLUSIONS
  The anti-HDV testing rate was low in a centre with clinic-led testing, but could not be evaluated in all centres. The HDV-infected patients were of diverse ethnicity, with extensive histological evidence of liver disease and poor therapeutic responses. Future recommendations include reflex laboratory testing algorithms and a prospective cohort study to optimise the investigation and management of these patients.
authors: University College London Hospitals NHS Foundation Trust, Department of Clinical Microbiology and Virology, 2nd Floor, 307 Euston Road, London NW1 3AD, UK. Electronic address: kate.elbouzidi@nhs.net.
authors: Kate
authors: K
authors: El Bouzidi
authors: Barts Health NHS Trust, Division of Infection, Pharmacy and Pathology Building, 80 Newark Street, London E1 2ES, UK.
authors: Wael
authors: W
authors: Elamin
authors: University College London Hospitals NHS Foundation Trust, Department of Clinical Microbiology and Virology, 2nd Floor, 307 Euston Road, London NW1 3AD, UK.
authors: Katharina
authors: K
authors: Kranzer
authors: Royal Free London NHS Foundation Trust, Department of Virology, Royal Free Hospital, Pond Street, London NW3 2QG, UK.
authors: Dianne N
authors: DN
authors: Irish
authors: University College London Hospitals NHS Foundation Trust, Department of Clinical Microbiology and Virology, 2nd Floor, 307 Euston Road, London NW1 3AD, UK.
authors: Bridget
authors: B
authors: Ferns
authors: Barts Health NHS Trust, Department of Hepatology, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.
authors: Patrick
authors: P
authors: Kennedy
authors: UCL Institute for Liver and Digestive Health, Royal Free Hospital, Pond Street, London NW3 2QG, UK.
authors: William
authors: W
authors: Rosenberg
authors: UCL Institute for Liver and Digestive Health, Royal Free Hospital, Pond Street, London NW3 2QG, UK.
authors: Geoffrey
authors: G
authors: Dusheiko
authors: UCL Research Department of Infection and Population Health Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK.
authors: Caroline A
authors: CA
authors: Sabin
authors: Imperial College Healthcare NHS Trust, Hepatology Research Unit, St. Mary's Hospital, Praed Street, London W2 1NY, UK.
authors: Belinda C
authors: BC
authors: Smith
authors: University College London Hospitals NHS Foundation Trust, Department of Clinical Microbiology and Virology, 2nd Floor, 307 Euston Road, London NW1 3AD, UK. Electronic address: e.nastouli@ucl.ac.uk.
authors: Eleni
authors: E
authors: Nastouli
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research; D006508:Hepatitis Antibodies / Q000097:blood*; D019694:Hepatitis B, Chronic / Q000150:complications; D003699:Hepatitis D / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D003698:Hepatitis Delta Virus / Q000276:immunology*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007372:Interferons / Q000627:therapeutic use; D008131:London / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged
chemical_list: D006508:Hepatitis Antibodies; D007155:Immunologic Factors; D007372:Interferons
keywords: Epidemiology; HBV; HDV; Management; Testing