{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:16:21Z","timestamp":1758845781129,"version":"3.44.0"},"reference-count":26,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,9,13]],"date-time":"2025-09-13T00:00:00Z","timestamp":1757721600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100005564","name":"Gilead Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005564","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Viral Hepatitis"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Delays in timely diagnosis and treatment of hepatitis delta virus (HDV) contribute to more severe liver disease at presentation. We aim to evaluate the prevalence and predictors of advanced liver disease at presentation among a national cohort of United States (U.S.) Veterans co\u2010infected with chronic hepatitis B (CHB) and HDV. We retrospectively evaluated all U.S. Veterans with chronic HBV from 1\/1\/2010 to 12\/31\/2024 who underwent anti\u2010HDV testing to evaluate the proportion who had advanced liver disease (cirrhosis, cirrhosis\u2010related complications and hepatocellular carcinoma) at the time of HDV diagnosis. We performed sensitivity analyses among those who completed HDV RNA testing. Prevalence of advanced liver disease at the time of HDV testing was compared between anti\u2010HDV positive and negative and among subgroups using chi\u2010square testing. Among 29,061 chronic HBV patients, we identified 3558 patients who completed HDV testing during the study period, among whom 108 (3.0%) were anti\u2010HDV positive and 3450 (97.0%) were anti\u2010HDV negative. Anti\u2010HDV positive patients had a significantly greater proportion of advanced liver disease compared to those who were anti\u2010HDV negative (32.4% vs. 15.2%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001). Sensitivity analyses among patients who completed HDV RNA testing demonstrated similar trends of advanced liver disease (45.5% in HDV RNA positive vs. 18.6% in HDV RNA neg, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Among a national cohort of U.S. Veterans with chronic HBV, nearly 1 in 3 had already developed advanced liver disease at the time of HDV diagnosis, reflecting dangerous delays in diagnosis and treatment. Implementing effective programmes (e.g., reflex testing) to improve timely HDV diagnosis and treatment is urgently needed to prevent liver\u2010related morbidity and mortality.<\/jats:p>","DOI":"10.1111\/jvh.70086","type":"journal-article","created":{"date-parts":[[2025,9,13]],"date-time":"2025-09-13T08:25:36Z","timestamp":1757751936000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["High Prevalence of Cirrhosis or Hepatocellular Carcinoma at Hepatitis Delta Infection Diagnosis Reflects Alarming Delays in Testing"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6092-2541","authenticated-orcid":false,"given":"Robert J.","family":"Wong","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology Stanford University School of Medicine  Stanford California USA"},{"name":"Gastroenterology and Hepatology Section Veterans Affairs Palo Alto Healthcare System  Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zeyuan","family":"Yang","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Section Veterans Affairs Palo Alto Healthcare System  Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Lim","sequence":"additional","affiliation":[{"name":"Section of Digestive Diseases and Yale Liver Center Yale University School of Medicine  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janice H.","family":"Jou","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine Oregon Health &amp; Science University Hospital  Portland Oregon USA"},{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, Portland VA Medical Center  Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramsey","family":"Cheung","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Stanford University School of Medicine  Stanford California USA"},{"name":"Gastroenterology and Hepatology Section Veterans Affairs Palo Alto Healthcare System  Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,9,13]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"crossref","unstructured":"B. V.John D.Bastaich M. M.Amoli et\u00a0al. \u201cAssociation of Hepatitis Delta Virus Infection and Hepatocellular Carcinoma Hepatic Decompensation All\u2010Cause and Liver\u2010Related Death in a National Cohort \u201dHepatology (2024).","DOI":"10.1097\/HEP.0000000000001162"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000000642"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.15638"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2021.100280"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-020-1168-9"},{"issue":"24","key":"e_1_2_12_7_1","article-title":"Hepatitis Delta Virus Testing and Prevalence Among Chronic Hepatitis B Patients Across Three U.S. Safety\u2010Net Health Systems","volume":"1542","author":"Wong R. 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Licence: CC BYNC\u2010SA 3.0 IGO (2024)."},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.15746"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.02.041"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.15529"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2022.100547"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.10.043"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000001195"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/jvh.13452"}],"container-title":["Journal of Viral Hepatitis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jvh.70086","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T11:14:46Z","timestamp":1758798886000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jvh.70086"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,13]]},"references-count":26,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1111\/jvh.70086"],"URL":"https:\/\/doi.org\/10.1111\/jvh.70086","archive":["Portico"],"relation":{},"ISSN":["1352-0504","1365-2893"],"issn-type":[{"type":"print","value":"1352-0504"},{"type":"electronic","value":"1365-2893"}],"subject":[],"published":{"date-parts":[[2025,9,13]]},"assertion":[{"value":"2025-04-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70086"}}