Seroconversion Rates of Hepatitis D Virus in Chronic Hepatitis B Patients in France and The Gambia
Overview
This study analyzed HDV seroconversion rates in 1016 HBsAg-positive individuals from France and The Gambia, revealing new HDV infections in both cohorts during follow-up. The incidence rates were similar between the two regions, supporting the need for repeated HDV testing in chronic hepatitis B patients.
Background
Hepatitis D virus (HDV) superinfection in hepatitis B virus (HBV) carriers leads to a more aggressive liver disease with faster progression to cirrhosis and hepatocellular carcinoma. Globally, approximately 5% of HBsAg-positive individuals are coinfected with HDV, but the timing of superinfection is often unknown. Current guidelines recommend at least one HDV screening in HBsAg-positive patients, yet repeated testing is not routinely performed. Early detection is critical due to limited treatment options and the availability of new therapies such as bulevirtide.
Data Highlights
Cohort
Number of Participants
Baseline HDV Prevalence
Median Follow-up (years)
New HDV Seroconversions
Incidence Rate (per 1000 patient-years)
The Gambia
625
1.1% (7/625)
5.98
14
3.85
France
391
2.5% (10/391)
2.1
3
3.70
Key Findings
Baseline HDV prevalence was 1.1% in The Gambia and 2.5% in France among HBsAg-positive individuals.
During follow-up, 14 new HDV seroconversions occurred in The Gambia cohort, with an incidence rate of 3.85 per 1000 patient-years.
In the French cohort, 3 new HDV seroconversions were detected, with an incidence rate of 3.70 per 1000 patient-years.
Patients in the French cohort were older, had higher liver enzyme levels, more often hepatitis B e antigen positive, and more advanced liver disease compared to the Gambian cohort.
HDV superinfection incidence is significant in both low- and high-prevalence regions, indicating ongoing transmission risk.
Current guidelines recommend only one-time HDV screening, but findings suggest repeated testing may be warranted.
Clinical Implications
Clinicians should consider implementing repeated HDV serology testing in HBsAg-positive patients to detect superinfection early, especially given the aggressive disease course associated with HDV. Awareness of HDV risk remains important even in regions with lower baseline prevalence. Early identification allows timely management and potential use of emerging therapies such as bulevirtide.
Conclusion
HDV superinfection occurs at a measurable incidence in chronic HBV carriers in both The Gambia and France, underscoring the need for repeated HDV screening to improve detection and patient outcomes.
References
Stockdale et al. 2023 -- Seroconversion Rates of Hepatitis D Virus in Individuals with Chronic Hepatitis B Virus Infection in France and The Gambia (Inci-D Study)
