Low coverage of hepatitis D virus testing in individuals with hepatitis B virus and HIV, the Netherlands, 2000 to 2022

Abstract

Background: Since 2009, European guidelines recommend individuals with hepatitis B virus (HBV) and HIV be tested for hepatitis D virus (HDV). Aim: To analyse HDV testing in individuals with HBV/HIV during routine practice in the Netherlands. Methods: We assessed data from the ATHENA cohort of people with HIV who were ever HBV surface antigen-positive, aged ≥ 18 years and attended one of 24 HIV treatment centres in the Netherlands during 2000–22. Using longitudinal analysis, we estimated the percentage of individuals ever tested for HDV (antibody or RNA test) over time. In cross-sectional analysis, determinants for ever being tested by end of follow-up were assessed using relative risk regression. Results: We identified 1,715 individuals with HBV/HIV; 1,460 (85.1%) and 255 (14.9%) were male and female at birth, respectively (median age: 52 years; IQR: 42–59). Only 249 (14.5%) had an HDV test. The percentage tested increased from 5.0% (95% CI: 3.4–7.3) in 2000 to 17.0% (95% CI: 14.9–19.3) in 2022. In 2022, 16.2% (95% CI: 13.7–19.1) of men who have sex with men, 25.0% (95% CI: 9.7–50.9) of persons who inject(ed) drugs and 18.1% (95% CI: 14.6–22.3) of heterosexual/others were tested. In multivariable analysis, ever having an HDV test was associated with detectable HBV DNA viral load (p < 0.001), ever presenting with elevated alanine aminotransferase (ALT) levels (p = 0.023), advanced fibrosis/cirrhosis (p=0.001) and being overweight/obese (p=0.043). Conclusions: HDV testing coverage in the Netherlands is low for individuals with HBV/HIV. Although testing was more common in those with advanced liver disease, a considerable proportion at risk of HDV still need testing.