New EXPO published in HEPATOLOGY provides timely, practical recommendations for HDV screening, diagnosis, monitoring and treatment amid advances in antiviral therapy.
DENVER (Nov. 6, 2026) — The American Association for the Study of Liver Diseases (AASLD) today announced the publication of its second Expert-Based Practice Opinion (EXPO), AASLD Expert-Based Practice Opinion (EXPO): Diagnosis and Management of Hepatitis Delta Virus (HDV) Infection, in its flagship journal, HEPATOLOGY. The new publication provides clinicians with timely, actionable recommendations for identifying, evaluating and treating hepatitis delta, one of the most severe forms of viral hepatitis.
Announced during The Liver Meeting® (TLM) 2026, AASLD’s premier annual gathering of liver disease experts, the new EXPO underscores the organization’s commitment to delivering timely, practical clinical guidance to the hepatology community.
A New Approach to Delivering Timely Clinical Guidance
AASLD's Expert-Based Practice Opinions (EXPO) represent a new approach to providing clinical guidance in areas where timely expert recommendations are needed but the available evidence may not support development of a traditional evidence-based practice guideline.
Commissioned by the AASLD Practice Guidelines Committee and developed by leading subject matter experts, EXPO documents draw on focused reviews of available scientific evidence and expert consensus to address important questions encountered in clinical practice. They complement AASLD's established practice guidelines by providing practical, evidence-informed recommendations in areas characterized by emerging therapies, rapidly evolving evidence or limited clinical data.
Following the publication of AASLD's inaugural EXPO on liver biopsy, this second publication demonstrates the organization's continued commitment to making relevant, expert-driven clinical guidance available to the hepatology community.
Addressing an Urgent Need in Hepatitis Delta Care
Hepatitis delta virus (HDV) is a serious viral infection that occurs only in individuals with hepatitis B virus (HBV) infection. Although relatively uncommon, HDV is associated with accelerated liver disease progression and an increased risk of cirrhosis, liver failure, liver cancer and liver-related mortality.
An estimated 12 million to 72 million people worldwide and up to 75,000 people in the United States may be affected by HDV infection. Despite its serious consequences, HDV remains underdiagnosed, underscoring the importance of improved screening and access to appropriate care.
The new EXPO comes at a pivotal time, as advances in antiviral treatment are creating new opportunities to improve outcomes for people living with chronic HDV infection.
Developed by a multidisciplinary panel of international experts, the publication offers a comprehensive clinical framework spanning screening and prevention, diagnosis, disease monitoring, antiviral treatment and management of special populations.
Key Recommendations from the New HDV EXPO
The publication emphasizes several important areas of clinical practice:
- Universal HDV screening for individuals with hepatitis B: All individuals who test positive for hepatitis B surface antigen (HBsAg) should undergo HDV antibody testing at least once, with HDV RNA testing to confirm active infection when antibody results are positive.
- Improved diagnostic pathways: Routine reflex testing is recommended to improve identification of HDV infection, with double reflex testing considered where feasible.
- Comprehensive evaluation and surveillance: Individuals with chronic HDV infection should undergo assessment of liver fibrosis, preferably using elastography, and regular monitoring for disease progression. Adults with chronic HDV infection should receive liver cancer surveillance every six months.
- Expanded consideration of antiviral treatment: All adults with chronic HDV viremia and compensated liver disease, including compensated cirrhosis, should be considered candidates for HDV-specific antiviral therapy.
- Guidance on emerging treatment options: The EXPO addresses the use of bulevirtide, including treatment selection, combination therapy with pegylated interferon alfa-2a, assessment of treatment response and post-treatment monitoring.
The publication also addresses care for patients with decompensated cirrhosis, liver transplantation, HIV coinfection, kidney disease and other special clinical circumstances.
"HDV has historically been challenging to diagnose and manage, but recent advances in screening and antiviral therapy are changing the treatment landscape," said Joseph K. Lim, MD, FAASLD, Yale School of Medicine. "This publication provides clinicians with a practical framework for identifying patients with HDV, evaluating their disease and making informed treatment decisions based on the best available evidence and expert consensus."
The publication is being announced in conjunction with the sessions From Evidence to Practice: New Guidelines on Hepatitis Delta, Pediatric Liver Transplantation, Primary Biliary Cholangitis, and Pruritus, to be held on Nov. 6 from 11 AM-12:30 PM MT, and Inside the Journals: AASLD EXPO on Hepatitis Delta Virus, to be held on Nov. 8 from 1:30-2 PM MT, highlighting the role of AASLD's expanding portfolio of guidance documents in advancing high-quality, evidence-informed liver care.
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About AASLD
The American Association for the Study of Liver Diseases (AASLD) is the leading organization of scientists and health care professionals committed to preventing and curing liver disease. AASLD fosters research that leads to improved treatment options for millions of liver disease patients and advances the science and practice of hepatology through educational conferences, training programs, professional publications, and partnerships with government agencies and sister societies.
About HEPATOLOGY
The premier publication in the field of liver disease, HEPATOLOGY publishes original, peer-reviewed articles concerning all aspects of liver structure, function and disease. Each month, the distinguished Editorial Board monitors and selects only the best articles on subjects such as immunology, chronic hepatitis, viral hepatitis, cirrhosis, genetic and metabolic liver diseases and their complications, liver cancer, and drug metabolism. Follow the journal on X at @HEP_Journal.