Submitted:
19 February 2026
Posted:
26 February 2026
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Abstract
Hepatitis delta (HDV) infection affects 5% of hepatitis B (HBV)-positive patients, is associated with an increased risk of cirrhosis and hepatocellular carcinoma but remains underdiagnosed. The first part of our « Delta Describe » study highlighted insufficient screening of HDV patients in metropolitan France. We report here their real-world management. Patients with at least one positive HDV RNA test performed in 2019 were identified through the main French public and private laboratories. In 2024, informed patients were interviewed and physicians supplemented the collected data. 547 patients were included, median age 44 years, mainly originated from Africa or Eastern Europe. HIV and Hepatitis C coinfections were reported in 15.2% and 4.6% respectively. Liver stiffness was assessed by FibroScan® (75.3%) primarily. Most patients knew the year of diagnosis and 69% their fibrosis stage. Liver related events occurred in 14.3% of patients, mainly cirrhosis decompensation (67.9%) and hepatocellular carcinoma (28.3%). Forty-five patients underwent liver transplantation. In 2024, 47.5% had undetectable HDV RNA. Among treated patients (n=387), 37.4% received bulevirtide with or without pegylated-interferon, and 62.6% nucleos(t)ide analogues (NUCs) only. In metropolitan France, HDV patients had access to specialized follow-up, to innovative therapies (bulevirtide), were mostly on NUCs and demonstrated good disease awareness.
