Determination of hepatitis D virus (HDV) viremia represents the "gold standard" for the diagnosis of HDV infection. Hepatitis B virus (HBV)-HDV coinfection frequently leads to end-stage liver disease and hepatocellular carcinoma.No commercial assay for HDV RNA quantification that includes automated nucleic acid extraction is available, and in-house PCR tests are not well standardized. However, knowledge of HDV RNA levels may give important information for patient management and could be a useful tool for monitoring the response to antiviral therapies. One platform that is widely used for HBV DNA or HCV RNA quantification is the Cobas Ampliprep/TaqMan system. Using the utility channel of this platform, we established a novel protocol for TaqMan-based HDV RNA quantification after automatic extraction of RNA by the Ampliprep system. The assay was specific and showed linearity over a wide range from 3 ؋ 10 2 to 10 7 copies/ml. Reproducibility was demonstrated by determination of the interrun and intrarun variabilities, which were similar to those achieved with the commercially available Cobas TaqMan assays for HCV RNA and HBV DNA. HDV RNA levels were stable in whole blood (n ؍ 4), plasma (n ؍ 3), and serum (n ؍ 3) samples at room temperature for up to 6 days. Importantly, HDV RNA viremia showed only minor fluctuations, with the log 10 coefficient of variation being between 1.3 and 11.2% for hepatitis delta patients studied every 2 weeks for up to 3 months (n ؍ 6), while a rapid viral decline was observed early during treatment with pegylated alfa-2a interferon (n ؍ 6). In conclusion, this novel automated HDV RNA assay is a useful tool for monitoring HDV-infected patients both before and during antiviral therapy.Hepatitis delta is the most severe form of chronic viral hepatitis in humans. The hepatitis delta virus (HDV) is a defective RNA virus which requires the hepatitis B virus (HBV) surface antigen (HBsAg) for complete replication and transmission, although the full extent of the HBV helper function has not been unexplored (27,34). The HDV genome is a small, 1,678-nucleotide single-stranded RNA with a circular configuration that can form a rod-like structure with at least 70% paired bases (16, 35). The HDV RNA encodes small and large hepatitis delta antigens as the sole proteins (34).Hepatitis delta occurs only in HBsAg-positive individuals either as an acute coinfection or as a superinfection in patients with chronic hepatitis B (9). Several studies have shown that chronic HDV infection leads to more severe liver disease than chronic HBV monoinfection, with the course of progression of the fibrosis being accelerated, the risk of hepatocellular carcinoma being increased, and early decompensation occurring in the setting of established cirrhosis (9,12,13,36). Simultaneous HBV and HDV infection has also been shown to be more severe than infection with HBV alone in chimpanzees (6).The current treatment options for patients with delta hepatitis are very limited, as alfa interferon is able to clear HDV only ...