Hepatitis D laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jolanta Marszalek, M.D. [2] João André Alves Silva, M.D. [3]

Overview

Laboratory Findings

Hepatitis D should be considered in any individual who is HBsAg positive or that has evidence of recent HBV infection. The diagnosis of acute hepatitis D is made after evaluation of serologic tests for the virus. Persons infected with HDV develop anti-HDV antibodies. Accordingly, every individual with an HBsAg positive test result, should be studied for the presence of anti-HDV IgG antibodies.[1] These antibodies usually persist in circulation for long periods of time, however they may become negative in some patients. During therapy, the decrease in the levels of HBsAg may help determine the adequate duration of treatment.

The active form of the HDV infection was initially diagnosed by the detection of anti-HDV IgM antibodies. However, today the acute infection is confirmed with real-time PCR, by detecting serum HDV RNA.[2]

Patients presenting with liver disease, following HDV infection, should be tested for anti-HDV IgM antibodies, even when the HDV RNA test is negative. This is due to the fact that the hepatitis D virus shows genome variability, which might lead to false-negative results.[3][4] Although the levels of HDV RNA in the serum do not correlate with the stage of the disease, or liver fibrosis, the HDV RNA quantification may be used to evaluate the response to the antiviral therapy.[5]

Genotyping

The use of genotyping as a diagnostic test is gaining acceptance among different countries, due to the association of HDV genotype 1 to a higher degree of liver disease and to a worst response to treatment with pegylated IFN.[6]

HDV genotyping is not indicated in North America and Europe as a diagnostic tool, not only because genotype 1 is the most common type in these regions, but also because different genotypes respond well to common antiviral treatments.[7]

Coinfection with HIV and HCV

Patients infected with the HDV should be screened for concomitant infection with HIV and HCV.[8][9][9]

The table below describes the significance of diagnostic markers in HDV infection. [1]

Diagnostic Markers Significance
Anti-HDV IgG antibody
  • Positive in persons exposed to HDV
  • Persists, even after viral clearance
Anti-HDV IgM antibody
  • Positive in acute infection
  • Negative in past infection
  • Persists in many patients with chronic infection
HDV RNA

Qualitative

  • Marker of HDV replication
  • Positive in chronic infection
  • Negative in spontaneous or treatment-induced viral clearance

Quantitative

  • Useful in monitoring or predicting treatment response
HBsAg

Qualitative

  • Must be positive for HDV infectivity

Quantitative

  • Positively correlated with HDV RNA
  • Falling titer signals HBsAg loss, and hence HDV clearance
  • Useful in monitoring or predicting treatment response
HBeAg
  • Negative in an estimated 85% of patients
  • Associated with detectable anti-HBe
HBV DNA

Quantitative

  • Suppressed by HDV
  • Negative or low levels in most patients
  • May be increased in patients with detectable HBeAg
  • Can reactivate after spontaneous or treatment-induced clearance of HDV
ALT
  • Increased in most patients
  • Does not correlate well with degree of histological liver damage

According to different studies, it hasn't been noted an association between HDV RNA levels, HBsAg titre, liver test results and the stage of liver disease. Therefore, liver biopsy remains an important tool to assess pathological changes in liver histology.[1]

Below is a diagram representing the assessment of patients with hepatitis D:

Hepatitis D diagnosis Adapted from Treatment Options for Hepatitis Delta Virus Infection - Springer Science[7]

References

  1. 1.0 1.1 1.2 Hughes SA, Wedemeyer H, Harrison PM (2011). "Hepatitis delta virus". Lancet. 378 (9785): 73–85. doi:10.1016/S0140-6736(10)61931-9. PMID 21511329.
  2. Mederacke I, Bremer B, Heidrich B, Kirschner J, Deterding K, Bock T; et al. (2010). "Establishment of a novel quantitative hepatitis D virus (HDV) RNA assay using the Cobas TaqMan platform to study HDV RNA kinetics". J Clin Microbiol. 48 (6): 2022–9. doi:10.1128/JCM.00084-10. PMC 2884474. PMID 20351206.
  3. Manesis EK, Schina M, Le Gal F, Agelopoulou O, Papaioannou C, Kalligeros C; et al. (2007). "Quantitative analysis of hepatitis D virus RNA and hepatitis B surface antigen serum levels in chronic delta hepatitis improves treatment monitoring". Antivir Ther. 12 (3): 381–8. PMID 17591028.
  4. Le Gal F, Gordien E, Affolabi D, Hanslik T, Alloui C, Dény P; et al. (2005). "Quantification of hepatitis delta virus RNA in serum by consensus real-time PCR indicates different patterns of virological response to interferon therapy in chronically infected patients". J Clin Microbiol. 43 (5): 2363–9. doi:10.1128/JCM.43.5.2363-2369.2005. PMC 1153793. PMID 15872267.
  5. Zachou K, Yurdaydin C, Drebber U, Dalekos GN, Erhardt A, Cakaloglu Y; et al. (2010). "Quantitative HBsAg and HDV-RNA levels in chronic delta hepatitis". Liver Int. 30 (3): 430–7. doi:10.1111/j.1478-3231.2009.02140.x. PMID 19840253.
  6. Su CW, Huang YH, Huo TI, Shih HH, Sheen IJ, Chen SW; et al. (2006). "Genotypes and viremia of hepatitis B and D viruses are associated with outcomes of chronic hepatitis D patients". Gastroenterology. 130 (6): 1625–35. doi:10.1053/j.gastro.2006.01.035. PMID 16697726.
  7. 7.0 7.1 Heidrich B, Manns MP, Wedemeyer H (2013). "Treatment options for hepatitis delta virus infection". Curr Infect Dis Rep. 15 (1): 31–8. doi:10.1007/s11908-012-0307-z. PMID 23242761.
  8. Cross TJ, Rizzi P, Horner M, Jolly A, Hussain MJ, Smith HM; et al. (2008). "The increasing prevalence of hepatitis delta virus (HDV) infection in South London". J Med Virol. 80 (2): 277–82. doi:10.1002/jmv.21078. PMID 18098143.
  9. 9.0 9.1 Heidrich B, Deterding K, Tillmann HL, Raupach R, Manns MP, Wedemeyer H (2009). "Virological and clinical characteristics of delta hepatitis in Central Europe". J Viral Hepat. 16 (12): 883–94. doi:10.1111/j.1365-2893.2009.01144.x. PMID 19566789.

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