Academy Exchange

  • 1.  Hepatitis D Testing

    Posted 10-08-2021 09:46
    Hello!

    I was wondering if anyone is regularly testing for Hepatitis D in their practice?

    Thank you!
    Milena Murray

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    Milena Murray, PharmD, MSc, BCIDP, AAHIVP
    Midwestern University
    Downers Grove, IL
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  • 2.  RE: Hepatitis D Testing

    Posted 10-08-2021 15:15
    We only test for hepatitis D in the setting of someone with hepatitis B surface antigen positive, or Chronic hep B. it is not apart of our normal screening but is in an order set for "chronic hep B initial"

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    Angela Kapalko
    Physician Assistant Chairperson for AAHIVM
    Philadelphia FIGHT CommunityHealth Centers
    Philadelphia PA
    akapalko@fight.org
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  • 3.  RE: Hepatitis D Testing

    Posted 10-10-2021 11:36

    For those stating there isn't much Hep D in the US – the truth is we have very little Idea how much Hep D there is in the US.

    Recent estimates say that 80% of chronic HBV patients aren't even diagnosed in the US and, as is clear from this discussion, many here don't even test their known chronic Hep B patients routinely.

    While it's true that often times HBV/HDV co-infection leads to more serious disease,  that isn't always the case and isn't even usually the case for patients that are infected with both at the same time. Superinfection with Hep D is usually a more severe form of disease.

    Since even anti-virally treated chronic HBV patients can spread HDV to other Hep B patients and since it can be a very serious disease, it is important to identify Hep D patients and thus stands to reason that all chronic Hep B patients should be screened at least once,

    especially if they are triply infected with HIV.

     

     

    Dr. Tom McQuaid FNP-BC, AAHIVS

    Doctor of Nursing Practice-Family Nurse Practitioner Board Certified

    HIV Specialist- American Academy of HIV Medicine

    Anchor Health Initiative

    30 Myano Lane, Suite 16

    Stamford, CT 06902

    203-674-1102 (office)

    917-566-3554 (cell)

    tmcquaid@anchorhealthinitiative.org

    signature_371662369

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    The information contained in this transmission may contain privileged and confidential information, including patient information protected by federal and state privacy laws. It is intended only for the use of the person(s) named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution, or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of the original message.





  • 4.  RE: Hepatitis D Testing

    Posted 10-08-2021 15:39
    There would be no reason to test someone who doesn't already have active hepatitis B, since that's required to get hepatitis D. People infected with both would usually have severe disease or acute exacerbations of hepatitis.

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    Joel Gallant, MD, MPH
    Santa Fe, NM
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  • 5.  RE: Hepatitis D Testing

    Posted 10-08-2021 15:41
    Hi there, we had a hepatologist recommend testing for HDV so of the whole 2 patients we had in HIV clinic with HBV coinfection, both were HDV ab neg.

    My understanding about testing is that HDV is worse prognosis or outcomes and so you can consider more frequent cirrhosis or hcc screening, there will possibly be some HDV treatments available in the future (treating HBV doesn't actually impact HDV, interestingly) and you only need an antibody test to screen patients.  It is pretty rare in the US so it likely isnt necessary to do serial hdv ab screens on patients with HBV.

    Alex





  • 6.  RE: Hepatitis D Testing

    Posted 10-08-2021 15:53

    Hello all,

     

    I am aware that there needs to be a diagnosis of HBV. I apologize for not being more clear in my earlier post.

     

    In your patients with hepatitis B, do you actively screen for hepatitis D?

     

    I hope this is a more direct question.

     

    Thank you,

    Milena Murray

     




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  • 7.  RE: Hepatitis D Testing

    Posted 10-08-2021 17:42
    We do test for HEP D only in HEP B infected patients, but in my experience (about 5,000 PLWHIV) I haven't see HIV HEPB+D patients; HEP B in Colombia has a trend to low and HEP C rise, and according to Instituto Nacional de Salud, I in 2019 only   2 cases of HEP B + D were reported.  One of them was a patient coming from Venezuela (healthcare has deteriorated a lot there since dictatorship) and no cases in 2020 I have attached  a graphic where you can see how HEP B has lowered and C raised  from: 

    https://www.ins.gov.co/buscador-eventos/Informesdeevento/HEPATITIS%20B,%20C%20Y%20COINFECCI%C3%93N%20B-DELTA_2020.pdf






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    William Lenis
    Fundacion Valle del Lili
    Cali
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  • 8.  RE: Hepatitis D Testing

    Posted 10-09-2021 15:27
    Sorry for the miscommunication: at our FQHC, it is standard practice that any patient diagnosed with chronic hep B to do hepatitis D testing. We in fact have 2 HIV patients with hep b/d infection and 5 non HIV patients with hep b/d that we identified on screening. Additionally, one of the HIV patients at one point in his history had quad infection of HIV, hepatitis C, hepatitis B and hep D. This was discovered in 2012 while treating his hepatitis C. This patient was the main reason we changed our screening process for hep b/d.

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    Angela Kapalko
    Physician Assistant Chairperson for AAHIVM
    Philadelphia FIGHT CommunityHealth Centers
    Philadelphia PA
    akapalko@fight.org
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