{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T22:02:44Z","timestamp":1792101764115,"version":"4.4.0"},"reference-count":41,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,10,30]],"date-time":"2023-10-30T00:00:00Z","timestamp":1698624000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aims<\/jats:title><jats:p>Previous studies have shown suboptimal screening for hepatitis D virus (HDV) among patients with chronic hepatitis B (CHB). This study presents the cascade of care for HDV infection in a major secondary referral centre in Southern Stockholm, Sweden.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>HBsAg+ve patients attending Karolinska University Hospital (KUH) from 1992 to 2022 were identified. The prevalence of anti\u2010HDV and\/or HDV RNA positivity, interferon (IFN) therapy and maintained virological responses (MVR) after HDV treatment were assessed. Also, time to anti\u2010HDV testing was analysed in relation to liver\u2010related outcomes with logistic regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 4095 HBsAg+ve persons, 3703 (90.4%) underwent an anti\u2010HDV screening; within a median of 1.8\u2009months (range 0.0\u201357.1) after CHB diagnosis. This screening rate increased over time, to 97.9% in the last decade. Overall, 310 (8.4%) were anti\u2010HDV+ve, of which 202 (65.2%) were HDV RNA+ve. Eighty\u2010five (42%) received IFN, and 9 (10.6%) achieved MVR at the last follow\u2010up. The predictive factors for anti\u2010HDV screening were Asian origin, diagnosis after the year 2012, HIV co\u2010infection (negative factor) and HBV DNA level\u2009&lt;\u20092000\u2009IU\/mL in univariable analysis, while HIV co\u2010infection was the only remaining factor in multivariable analysis. Delayed anti\u2010HDV test &gt;5\u2009years was independently associated with worsened liver\u2010related outcomes (adjusted odds ratio\u2009=\u20097.6, 95% CI 1.8\u201331.6).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Higher frequency of HDV screening than previously published data could be seen among CHB patients at KUH in a low\u2010endemic setting. Receiving a delayed screening test seems to be associated with worse outcomes, stressing the need of a strategy for timely HDV diagnosis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.15770","type":"journal-article","created":{"date-parts":[[2023,10,31]],"date-time":"2023-10-31T05:00:13Z","timestamp":1698728413000},"page":"228-240","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The cascade of care for patients with chronic hepatitis delta in Southern Stockholm, Sweden for the past 30\u2009years"],"prefix":"10.1111","volume":"44","author":[{"given":"Habiba","family":"Kamal","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases Karolinska University Hospital  Stockholm Sweden"},{"name":"Department of Medicine Huddinge Karolinska Institute  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Lindahl","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Karolinska University Hospital  Stockholm Sweden"},{"name":"Department of Medicine Huddinge Karolinska Institute  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Ingre","sequence":"additional","affiliation":[{"name":"Department of Medicine Huddinge Karolinska Institute  Stockholm Sweden"},{"name":"Centre for Bioinformatics and Biostatistics Karolinska Institute  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Gahrton","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Karolinska University Hospital  Stockholm Sweden"},{"name":"Department of Medicine Huddinge Karolinska Institute  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerstin","family":"Karkkonen","sequence":"additional","affiliation":[{"name":"Department of Medicine Huddinge Karolinska Institute  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Nowak","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Karolinska University Hospital  Stockholm Sweden"},{"name":"Department of Medicine Huddinge Karolinska Institute  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Vesterbacka","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Karolinska University Hospital  Stockholm Sweden"},{"name":"Department of Medicine Huddinge Karolinska Institute  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"St\u00e5l","sequence":"additional","affiliation":[{"name":"Department of Medicine Huddinge Karolinska Institute  Stockholm Sweden"},{"name":"Department of Upper GI Diseases Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2906-0480","authenticated-orcid":false,"given":"Heiner","family":"Wedemeyer","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University of Hannover  Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann\u2010Sofi","family":"Duberg","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Faculty of Medicine and Health \u00d6rebro University  \u00d6rebro Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soo","family":"Aleman","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Karolinska University Hospital  Stockholm Sweden"},{"name":"Department of Medicine Huddinge Karolinska Institute  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,10,30]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"New WHO Guidance on Viral Hepatitis Elimination.https:\/\/www.natap.org\/2021\/EASL\/EASL_34.htm. 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