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For US HCPs Only

Your patients with hepatitis B virus (HBV)
may be living with hepatitis delta virus (HDV).1

HDV lettering filled with a portrait and outdoor imagery

Don’t let it go undetected

All patients who are positive for hepatitis B surface antigen (HBsAg+)
should be
tested for HDV2–4

  1. Test For anti-HDV antibodies
  2. Confirm Active infection with HDV
    RNA reflex test
  3. If positive for HDV
  4. Treat or consider referral for specialist evaluation and management

New treatment options are available.5

HDV reflex testing in all HBsAg+ patients resulted in 5 X increase in HDV
diagnoses vs risk-based care6

If HBV is confirmed, HDV may be present too7

HDV requires HBV to infect and replicate

Chronic hepatitis delta (CHD) is the most aggressive form of viral hepatitis.

Early detection matters

  • CHD can lead to fibrosis, liver cancer, and death.8
  • 70% to 80% of people with CHD develop cirrhosis within 5 to 10 years vs slower disease progression with HBV monoinfection.9,10

Risk-based testing may underestimate the number of patients with CHD

  • Variations in testing guidelines, risk-based screening practices, and stigma all contribute to underdiagnosis of CHD.7,11
    • In 1 analysis, 60% of patients with CHD did not have any risk factors.6

In the United States, 1 in 20
patients with HBV test positive for HDV1

The American Gastroenterological Association (AGA) and the Chronic Liver Disease Foundation (CLDF) both recommend universal HDV screening for all patients who test positive for HBsAg.12,13

  1. Test all patients who are HBsAg+ at least once.2

  2. Retest patients with risk factors annually.2

Consider retesting when clinically indicated, including unexplained ALT flares or rapidly progressing liver disease.2

Universal reflex testing is available through major US reference labs

HDV REFLEX testing: click on links for access14–18

Test codes
LabCorp:
550672 and 144012
Quest Diagnostics:
37231
ARUP:
3006379
Mayo Clinic:
AHDV
CPT codes for billing
86692
(Anti-HDV antibody)
If reflexed, add 87523
(HDV RNA)

Double reflex testing is available for patients being evaluated for HBV. Patients who are HBsAg+ are double reflexed for HDV, using the same specimen. Double reflex testing is available at LabCorp and ARUP.19,20

HBV/HDV DOUBLE REFLEX testing: click on links for access

Test codes
LabCorp:
006514
ARUP:
3018776
CPT codes for billing

87340

If reflexed, add 87341, 86692, 87523

HDV Testing Brochure

This resource outlines identification and testing, including laboratory billing codes

View the brochure

The Hepatitis B Foundation offers HDV resources, including facts and figures, additional details on testing, and information for patients at Hepatitis Delta Connect.

References:

  1. Gish RG, Jacobson IM, Lim JK, et al. Prevalence and characteristics of hepatitis delta virus infection in patients with hepatitis B in the United States: An analysis of the All-Payer Claims Database. Hepatology. 2024;79:1177-1182.
  2. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on hepatitis delta virus. J Hepatol. 2023;79(2):433-460.
  3. Lange M, Zaret D, Kushner T. Hepatitis delta: current knowledge and future directions. Gastro & Hepatol. 2022;18(9):508-520.
  4. Bajis S, Luhmann N, Okamoto E, et al. Who to test and reflex testing for hepatitis D virus infection: evidence and rationale to inform policy recommendations and future directions. Lancet Gastroenterol Hepatol. 2026;11:417-425.
  5. FDA. FDA Approves First Treatment for Chronic Hepatitis Delta Virus (HDV) Infection. May 22, 2026.
  6. Palom A, Rando-Segura A, Vico J, et al. Implementation of anti-HDV reflex testing among HBsAg-positive individuals increases testing for hepatitis D. JHEP Rep. 2022;4:100547.
  7. Comberg M, Zoulim F, Gish R, et al. Best practices for screening, testing, diagnosing, and treating patients with hepatitis D (delta) virus based on global expert review and recent guidelines. Antiviral Therapy. 2025;30(4):1-15.
  8. Nathani R, Leibowitz R, Giri D, et al. The Delta Delta: Gaps in screening and patient assessment for hepatitis D virus infection. J Viral Hepat. 2023;30:195-200.
  9. Zhang Z, Urban S. New insights into HDV persistence: The role of interferon response and implications for upcoming novel therapies. J Hepatol. 2021;74:686-699.
  10. Negro F, Lok AS. Hepatitis D: a review. JAMA. 2023;330(24):2876-2387.
  11. Hon S, Lee DL, Martin P, Jones PD. Providers’ perspectives of hepatitis Delta virus screening and recommendations for improvement: a qualitative investigation. Gastro Hep Adv. 2025;4:100743.
  12. Kushner T, Cohen SM, Ahn J, Wong RJ. AGA Clinical Practice Update on Management of Hepatitis Delta: Commentary. Gastroenterology. 2025;169(5):1063-1069.
  13. Pan C, Gish R, Jacobson IM, et al. Diagnosis and management of hepatitis Delta virus infection. Digestive Diseases and Sciences. 2023;68:3237-3248.
  14. Labcorp. Reflex Hepatitis D Virus (HDV) RNA, Quantitative PCR (Test No. 550672).
  15. Labcorp. Hepatitis D Virus (HDV) Antibody, IgG and IgM (Test Number 144012).
  16. Quest Diagnostics. Hepatitis D Virus (HDV) Antibody, Total with Reflex to HDV, Real-Time PCR (Test code 37231; CPT code 86692).
  17. ARUP Laboratories. Hepatitis Delta Virus Antibody by ELISA With Reflex to Hepatitis Delta Virus by Quantitative PCR (Test No. 3006379, HEPD AB GR). 2026.
  18. Mayo Clinic Laboratories. Test Definition: AHDV — Hepatitis D Virus (HDV) Total Antibodies with Reflex to HDV RNA Detection and Quantitation, PCR, Serum. Generated August 7, 2026.
  19. Labcorp. Hepatitis B Surface Antigen (HBsAg) Screen, Qualitative with Reflex to Hepatitis D Virus (HDV) Antibody, Test No. 006514, CPT 87340. Accessed August 10, 2026.
  20. ARUP Laboratories. Hepatitis B Virus Surface Antigen with Reflex to Confirmation and Reflex to Hepatitis Delta Virus Antibody by ELISA With Reflex to Hepatitis Delta Virus by Quantitative PCR (Test Number 3018776, 2026).