Impact of therapy for hep b on hep d

Hello, I am a chronic hep b patient on tenofovir for almost a year now. I was not tested for hep delta before starting the therapy with tenofovir. I checked anti HDV and tested negative. My liver enzymes are consistently going up so I asked my doctor to check again hep delta. He said it is not possible to check if I have it or not because Hbv dna is not detectable and HDV needs Hbv. This is not consistent with what I have known. HDV needs HBS Ag which I still have plenty - 20000 iu/ml. My question is - is there a way of finding out if I have hep delta now that I am on tenofovir for hep b? Is the result I have for anti HDV reliable or can tenofovir lead to misleading results? Thank you!

Hi @natti,

This is a great question and you are correct. Being on Tenofovir does not stop HDV at all. Yes, anti-HDV tests should still be reliable even on treatment.

This is a common misconception that I too have experienced, even in liver specialist clinicians.

Hope this helps.
Thomas

Dear @ThomasTu,

Thank you so much for your response.

Do you think it would make sense for me to have HDV Dna load tested or is the negative test for anti-HDV enough? I assume the HDV DNA is quite costly.

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Great question again, @Natti.

The widely-accepted screening method (supported by WHO) is to only test HDV RNA if you are HDV-antibody positive, which suggests to me that HDV antigen is reliable and sufficient for testing. You are right that HDV RNA testing is more expensive.

Yours sincerely,
Thomas

you are right that even if hep b is zero, still you can have hep delta becuase hep delta need hbsag only.

i suggest you do hep delta quantitative if you can afford to do so

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Thank you, much appreciated!!!

Thank you Suresh! I hope I can find a lab that actually tests hep d. Turns out it is not easy.

What country are you in? Sorry your doctor won’t test or send you to a blood work place to test. It literally cost him nothing to do so.

I believe if a patient wants medical services, the doctor should help them get access to them. I hate reading stuff like this. Sorry for your worries.

Thank you! I am in Germany. I am trying to do it on my own now but it is so rare that apparently no lab does it…

Germany is one of the few countries which has the labs to do and they have new drug to treat Hep delta

This drug (bulevirtide) is also available in France along with excellent testing facilities for HDV.

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@availlant thank you! I hope I will get the option of testing it in Germany. I tested negative for anti-hdv but was told that HDV should be done if ALAT and ASAT are above norm and y-GT is going up (still in the norm but rising).

Dear Natti,

HDV RNA will provide a definitive result.

Looking back through your posts I wanted to confirm one item regarding HBV, TDF therapy and HDV.

TDF suppresses viral replication but not the production of non-infectious subviral particles (SVP, which form > 99.99% of HBsAg). HDV virions are produced independently from HBV replication using the SVP pathway. This is why TDF is ineffective against HDV.

Hope this helps.

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