Screening for hepatitis B, C and D in metropolitan France from 2016 to 2022: A map based on the National Health Data System with a focus on HDV screening

Background According to the latest World Health Organization report, the incidence and mortality rates of viral hepatitis, including hepatitis delta infection, have increased in recent years. The simultaneous screening of these viruses and HIV remains important for containing their spread or eliminating them. Many treatments are now available that can either cure or limit the complications of these infections. Delta infection, which affects 5% of hepatitis B (HBV)-positive patients, is largely underestimated, whereas the prevalence of delta cirrhosis and hepatocellular carcinoma (HCC) is 3 to 5 times greater than that of HBV monoinfection. The real-life prevalence of hepatitis delta virus (HDV) in metropolitan France has rarely been studied. Methods This study aimed to determine the number of HCV, HIV, HBV and HDV screening tests performed from 2016–2022 based on data from the French National Health Data System. We compared the results of HDV Ab tests with the number of expected HDV Ab tests, which was calculated based on the estimate of positive HBV screening in France (0.7%). Results From 2016–2022, 28,314,766 anti-HCV Ab tests, 29,463,042 anti-HIV Ab tests, 28,898,177 HBs Ag tests, 162,055 anti-HDV Ab tests and 21,963 HDV RNA tests were performed. We observed an increase of 39%, 30%, 45%, 130% and 206% respectively, during this period. Fifty-five percent of the expected anti-HDV Ab tests were carried out in 2016, 69% were carried out in 2020, and 94.7% were carried out in 2022. However, with respect to two specific populations in 2022, only 0.26% of pregnant women and 26% of patients monitored for chronic HBV infection underwent an anti-HDV Ab test. The patients screened for HBs Ag, anti-HCV Ab, anti-HIV Ab and anti-HDV Ab were mainly in the Ile de France and Provence-Alpes-Côte d’Azur regions. A total of 41.7% of the patients tested for anti-HDV Ab and 51.8% of the patients tested for HDV RNA had a precarious profile. HDV screening test prescribers were hospital-based, and HBV, HCV and HIV test prescribers worked mainly in the private sector. Conclusion In total, HDV screening increased 2.3-fold from 2016 to 2022 but remained insufficient in some populations.