HBV Hepatitis Delta Screening Guidelines: New Recommendations for HDV Screening in HBV Patients

2025 guidelines expand HDV screening; routine testing is now recommended for all patients with hepatitis B to detect co-infection earlier and connect screening to treatment decisions.

Compared with prior practice, HDV screening shifts from risk‑based case finding to routine testing of all HBV‑positive patients. The guideline recommends initial anti‑HDV serology with reflex HDV RNA testing for seropositive results, applied to known HBV patients, newly diagnosed individuals, and those with elevated ALT or advanced fibrosis. Immediate RNA confirmation establishes active replication and informs antiviral or referral decisions, aligning screening with downstream treatment eligibility.

HDV co‑infection drives more aggressive liver disease and worse outcomes in HBV‑positive patients, including faster progression to cirrhosis and higher rates of decompensation than HBV mono‑infection. Because co‑infected patients follow distinct management pathways and may qualify for emerging HDV therapies, earlier identification alters prognosis and therapeutic planning and shortens the window to intervention.

However, there are key clinical and operational implications. Common barriers include awareness gaps, limited laboratory HDV RNA capacity, cost constraints, and absent reflex testing pathways. Practical mitigations include standardized EHR order sets, contractual reflex algorithms with reference laboratories, point‑of‑care prompts at HBV diagnosis, and targeted primary‑care engagement.

Integrating these steps into routine HBV care will operationalize the guideline recommendations and improve screening and disease‑management outcomes.

Key Takeaways:

• Routine HDV screening for all HBV patients replaces selective testing—implement anti‑HDV with reflex RNA for known HBV patients, new diagnoses, and those with elevated ALT or advanced fibrosis. Embedding this into standard HBV panels reduces missed co‑infections and streamlines laboratory workflow.
• Primary care clinicians typically order initial serology; hepatology and infectious‑disease teams confirm HDV RNA and manage positive cases. Expect increased referrals and a larger pool of patients eligible for HDV‑directed treatment.
• Update EHR order sets, enable reflex lab pathways, and add concise patient‑counseling scripts at diagnosis to shorten time to treatment and clarify management trajectories.