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

Anders Boyd; Colette Smit; the AIDS Therapy Evaluation in the Netherlands (ATHENA) Observational HIV Cohort; Annemiek A. van der Eijk; Hans Zaaijer; Bart J.A. Rijnders; Berend van Welzen; Mark A.A. Claassen; Katalin Pogány; Theodora E.M.S. de Vries-Sluijs; Eline Op de Coul; Marc van der Valk

doi:10.2807/1560-7917.ES.2025.30.7.2400344

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

Anders Boyd^*
, Colette Smit
, the AIDS Therapy Evaluation in the Netherlands (ATHENA) Observational HIV Cohort
, Annemiek A. van der Eijk
, Hans Zaaijer
, Bart J.A. Rijnders
, Berend van Welzen
, Mark A.A. Claassen
, Katalin Pogány
, Theodora E.M.S. de Vries-Sluijs
, Eline Op de Coul
, Marc van der Valk

^*Corresponding author for this work

Stichting HIV Monitoring
University of Amsterdam
Amsterdam UMC
Municipal Health Service of Amsterdam
Utrecht University
Rijnstate Hospital
Maasstad Hospital
National Institute of Public Health and the Environment

Research output: Contribution to journal › Article › Academic › peer-review

3 Citations (Scopus)

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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.

Original language	English
Journal	Eurosurveillance
Volume	30
Issue number	7
DOIs	https://doi.org/10.2807/1560-7917.ES.2025.30.7.2400344
Publication status	Published - 20 Feb 2025

Bibliographical note

Publisher Copyright:
© 2025 European Centre for Disease Prevention and Control (ECDC). All rights reserved.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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Low coverage of hepatitis D virus testing in individuals with hepatitis B virus and HIV, the Netherlands, 2000 to 2022Final published version, 451 KBLicence: CC BY

Cite this

Boyd, A., Smit, C., the AIDS Therapy Evaluation in the Netherlands (ATHENA) Observational HIV Cohort, van der Eijk, A. A., Zaaijer, H., Rijnders, B. J. A., van Welzen, B., Claassen, M. A. A., Pogány, K., de Vries-Sluijs, T. E. M. S., de Coul, E. O., & van der Valk, M. (2025). Low coverage of hepatitis D virus testing in individuals with hepatitis B virus and HIV, the Netherlands, 2000 to 2022. Eurosurveillance, 30(7). https://doi.org/10.2807/1560-7917.ES.2025.30.7.2400344

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title = "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.",

author = "Anders Boyd and Colette Smit and \{the AIDS Therapy Evaluation in the Netherlands (ATHENA) Observational HIV Cohort\} and \{van der Eijk\}, \{Annemiek A.\} and Hans Zaaijer and Rijnders, \{Bart J.A.\} and \{van Welzen\}, Berend and Claassen, \{Mark A.A.\} and Katalin Pog{\'a}ny and \{de Vries-Sluijs\}, \{Theodora E.M.S.\} and \{de Coul\}, \{Eline Op\} and \{van der Valk\}, Marc",

year = "2025",

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day = "20",

doi = "10.2807/1560-7917.ES.2025.30.7.2400344",

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volume = "30",

journal = "Eurosurveillance",

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Boyd, A, Smit, C, the AIDS Therapy Evaluation in the Netherlands (ATHENA) Observational HIV Cohort, van der Eijk, AA, Zaaijer, H, Rijnders, BJA, van Welzen, B, Claassen, MAA, Pogány, K, de Vries-Sluijs, TEMS, de Coul, EO & van der Valk, M 2025, 'Low coverage of hepatitis D virus testing in individuals with hepatitis B virus and HIV, the Netherlands, 2000 to 2022', Eurosurveillance, vol. 30, no. 7. https://doi.org/10.2807/1560-7917.ES.2025.30.7.2400344

TY - JOUR

T1 - Low coverage of hepatitis D virus testing in individuals with hepatitis B virus and HIV, the Netherlands, 2000 to 2022

AU - Boyd, Anders

AU - Smit, Colette

AU - the AIDS Therapy Evaluation in the Netherlands (ATHENA) Observational HIV Cohort

AU - van der Eijk, Annemiek A.

AU - Zaaijer, Hans

AU - Rijnders, Bart J.A.

AU - van Welzen, Berend

AU - Claassen, Mark A.A.

AU - Pogány, Katalin

AU - de Vries-Sluijs, Theodora E.M.S.

AU - de Coul, Eline Op

AU - van der Valk, Marc

PY - 2025/2/20

Y1 - 2025/2/20

N2 - 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.

AB - 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.

UR - https://www.scopus.com/pages/publications/85219048818

U2 - 10.2807/1560-7917.ES.2025.30.7.2400344

DO - 10.2807/1560-7917.ES.2025.30.7.2400344

M3 - Article

C2 - 39980422

AN - SCOPUS:85219048818

SN - 1025-496X

VL - 30

JO - Eurosurveillance

JF - Eurosurveillance

IS - 7

ER -

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

Abstract

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