Background & Aims Low hepatitis delta prevalence estimates in the United States are likely biased due to low testing rates. The objectives of this study were to quantify the prevalence of testing and identify factors associated with hepatitis D positive status among chronic hepatitis B patients in the Veterans Health Administration Methods We performed a nationwide retrospective study of all veterans who tested positive for HBsAg from October 1999 to December 2013. Hepatitis D antibody testing results were used to stratify patients into 3 groups: HDV-positive, HDV-negative and HDV-not tested. Demographics, comorbidities, additional laboratory data and clinical outcomes were compared across these groups of patients using standard statistical approaches. Results Among 25,603 patients with a positive hepatitis B surface antigen, 2,175 (8.5%) were tested for HDV; 73 (3.4%) patients tested positive. Receiving HDV testing was associated with receipt of testing for HBV, HIV, and HCV. Predictors of positive HDV results included substance abuse and cirrhosis. Fitting a predefined high-risk profile (abnormal ALT with suppressed HBV DNA titers) was strongly associated with testing positive for HDV (OR 4.2, 95%CI 1.9–9.3). Most (59%) of HDV-positive patients were HCV co-infected. HDV-positive subjects had higher risks of all-cause mortality. Incidence rates of hepatocellular carcinoma were 2.9 fold higher in HDV-positive relative to HDV-negative individuals (p=0.002). In adjusted analyses, HDV was independently associated with HCC (OR 2.1, 95%CI 1.1–3.9). Conclusions Testing rates for hepatitis delta in chronic hepatitis B patients in the United States are inappropriately low. Approaches to increase testing for HDV particularly in high-risk subsets should be explored.

Hepatitis C has increasingly affected women of child‐bearing age over the past few years as a result of the opioid epidemic. In this review, we discuss the effect of hepatitis C on pregnancy outcomes, effect of pregnancy on hepatitis C, as well as implications on management of hepatitis C during pregnancy.

Background: Liver injury is commonly seen in coronavirus disease 2019 (COVID-19). However, the mechanism behind liver injury, particularly in severe and critical COVID-19 patients, remains unclear and the clinical course is poorly described. Methods: We conducted a single-center, retrospective cohort study of consecutive hospitalized severe and critically ill COVID-19 patients with or without liver injury who underwent immunologic testing (IL-6, IL-8, TNF-α, and IL-1ß). Liver injury was defined as peak aminotransferases ≥3x ULN

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Pregnancy-associated hepatitis B flare occurred in 14% during pregnancy and 16% post-delivery and rarely led to hepatic decompensation. Positive HBeAg was the main risk factor identified. Women did not have adequate HBV monitoring or follow-up during pregnancy.

There is a rising prevalence of hepatitis C (HCV) among women of child‐bearing age nationally, which prompted a recommendation by national guidelines to screen all women for HCV during pregnancy. Women with HCV during pregnancy are at risk of perinatal transmission of HCV. Directly acting antiviral (DAA) therapy during pregnancy can potentially reduce the risk of perinatal transmission as well as cure women while they are engaged in antenatal care. However, data on the safety and efficacy of DAAs during pregnancy are limited. We aimed to evaluate the preferences of women with HCV regarding potential DAA treatment during pregnancy. We conducted a survey of women with a history of HCV followed in the University of California, San Francisco HCV clinic and in the Women’s Interagency HIV Study (most of whom are coinfected with HIV) to determine their preferences for DAA treatment during pregnancy. A total of 141 women completed the survey. Sixty percent reported that they would be willing to take antepartum DAA therapy if it lowered the risk of perinatal transmission. Only 21% reported that they would agree to take DAA therapy during pregnancy for self‐cure; 20% of women stated that they would not, yet indicated that they might change their minds if there were more human data available regarding use of DAAs during pregnancy. In multivariable analysis, having a previous history of taking DAAs and being of childbearing age at the time of the survey were associated with willingness to take DAA medication during pregnancy (odds ratios 4.29 and 4.11, respectively). Conclusion: These results point to the need for further investigation of the role of HCV therapy during pregnancy.

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