The American Gastroenterological Association (AGA) issued new guidance on managing hepatitis delta virus (HDV), focusing on updated approaches to screening, diagnosis, and treatment.

An estimated 30,000 to 60,000 people in the U.S. have active HDV infection; prevalence is highest among people who inject drugs (43.8%), those with HIV (6.7%), and non–U.S.-born individuals (4.2%).

The AGA recommends universal HDV screening for all chronic HBV patients using anti-HDV antibody testing followed by HDV RNA confirmation.

Patients with HDV should undergo noninvasive cirrhosis evaluation and be included in liver cancer surveillance programs.

Pegylated interferon-alpha remains the only approved treatment in the U.S., achieving 23% to 57% response rates with frequent relapse after discontinuation.

New drugs—such as bulevirtide, brelovitug, tobevibart plus elebsiran, lonafarnib, and REP2139—are in advanced trials, showing improved viral suppression and safety.