Clinical Scorecard: Seroconversion Rates of Hepatitis D Virus in Individuals with Chronic Hepatitis B Virus Infection in France and The Gambia (Inci-D Study)
At a Glance
Category
Detail
Condition
Chronic hepatitis B virus (HBV) infection with potential hepatitis D virus (HDV) superinfection
Key Mechanisms
HDV requires HBV envelope for replication; superinfection leads to aggressive chronic liver disease
Target Population
HBsAg-positive individuals in The Gambia and France
Care Setting
Hospital-based and population-based cohorts in Europe and West Africa
Key Highlights
HDV superinfection incidence was approximately 3.7–3.85 per 1000 patient-years in both cohorts.
HDV superinfection leads to more aggressive liver disease with faster progression to cirrhosis and higher risk of hepatocellular carcinoma compared to HBV monoinfection.
Current guidelines recommend at least one HDV serology screening in all HBsAg-positive individuals, but repeated testing is not yet standard.
Guideline-Based Recommendations
Diagnosis
Screen all HBsAg-positive individuals once for HDV serology (EASL, APASL).
Risk-adapted screening recommended by AASLD for PWID, HIV-coinfected, MSM, and unexplained ALT elevation with low HBV DNA.
Bulevirtide approved as first specific anti-HDV drug, used alone or with pegylated interferon.
Emerging therapies under investigation include monoclonal anti-HBs antibodies and small interfering RNAs.
Monitoring & Follow-up
Repeated HDV serology testing in HBsAg-positive individuals may be considered due to observed superinfection incidence.
Surveillance currently relies on physician discretion and patient risk factors.
Risks
HDV superinfection accelerates liver disease progression, increasing risks of cirrhosis, decompensation, and hepatocellular carcinoma.
Higher prevalence in individuals with high-risk behaviors such as PWID, MSM, CSWs, and dialysis recipients.
Patient & Prescribing Data
HBsAg-positive individuals in diverse geographic settings (The Gambia and France)
New HDV infections occur during follow-up, supporting the need for repeated HDV testing to identify candidates for emerging therapies like bulevirtide.
Clinical Best Practices
Perform at least one HDV serology screening in all HBsAg-positive patients.
Consider repeated HDV testing during follow-up, especially in high-risk populations or regions with known HDV prevalence.
Early identification of HDV superinfection is critical to optimize management and improve outcomes.
Monitor liver enzymes and HBV markers to identify candidates for HDV testing.
Stay updated on emerging HDV therapies to offer improved treatment options.
