Nationwide Implementation of Double Reflex Testing for Hepatitis Delta in Spain: Results From the Retrospective Phase of the Spain‐DDR Study
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2026
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| author | Ana Alberola Adolfo de Salazar Ana Fuentes Raquel Carracedo Marta Illescas‐López María del Carmen Rodríguez Baños Carolina Freyre Berta Becerril Isabel Viciana Inmaculada López‐Rodríguez Natalia Montiel Ana María Domínguez Castaño María Pilar Luzón‐García Encarnación Ramírez Arellano Carmen Liébana‐Martos Francisco Franco Álvarez de Luna María del Carmen Lozano Begoña Palop Antonio Sampedro Ana Belén Pérez Sonia Algarate Susana Rojo Alba Pablo Fraile Dolores Ocete María Jesús Alcaraz Juan Carlos Rodríguez Francisco Javier Hernández‐Felices Olalla Martínez Victoria Domínguez Nieves Orta Dolores Gómez Carmen Cortell Jorge Camacho Susana Sabater Luis Ángel Iglesias Sánchez Yasmina Martín Aldara Vallejo Lourdes Molina María Aroca Beatriz Castro Magdalena Lara María José Pena Ana Rodríguez‐Fernández Alejandro González Praetorius José Joaquín Blas Alicia Beteta César Gómez María José Rodríguez Soledad Illescas Melanie Abreu Julio García Díez Inocencio Beltrán Marta Sandoval Torrientes Ruth Sáez Teresa Martín Pilar Tajada Alegre Belén Lorenzo María Teresa García Valero Isabel Jiménez Sansegundo Susana García‐de Cruz Sonsoles Garcinuño Miguel Ángel Sáiz Santiago Muñoz Isabel Fernández Helena Miriam Lorenzo Juanes María Reyes Vidal‐Acuña Luz María Moldes Noelia Calvo Matilde Trigo María José Gude Patricia Ordóñez Sandra Cortizo Miriam Blasco Mayra Sigcha Iker Falces Juan Carlos Galán Ana Arribi Roberto Alonso Asunción Iborra María Jesús del Amor Espín Eva Cascales Cayetano Pérez Pablo Fernández María Dolores Navarro María Luz Nuñez Jorge Galán Ros Luis Javier Gil‐Gallardo Ana Miqueleiz Gabriel Reina Luis Elorduy Mikele Macho Carmen Gómez Paloma Liendo Yolanda Salicio Antonio Aguilera Federico García |
| author_facet | Ana Alberola Adolfo de Salazar Ana Fuentes Raquel Carracedo Marta Illescas‐López María del Carmen Rodríguez Baños Carolina Freyre Berta Becerril Isabel Viciana Inmaculada López‐Rodríguez Natalia Montiel Ana María Domínguez Castaño María Pilar Luzón‐García Encarnación Ramírez Arellano Carmen Liébana‐Martos Francisco Franco Álvarez de Luna María del Carmen Lozano Begoña Palop Antonio Sampedro Ana Belén Pérez Sonia Algarate Susana Rojo Alba Pablo Fraile Dolores Ocete María Jesús Alcaraz Juan Carlos Rodríguez Francisco Javier Hernández‐Felices Olalla Martínez Victoria Domínguez Nieves Orta Dolores Gómez Carmen Cortell Jorge Camacho Susana Sabater Luis Ángel Iglesias Sánchez Yasmina Martín Aldara Vallejo Lourdes Molina María Aroca Beatriz Castro Magdalena Lara María José Pena Ana Rodríguez‐Fernández Alejandro González Praetorius José Joaquín Blas Alicia Beteta César Gómez María José Rodríguez Soledad Illescas Melanie Abreu Julio García Díez Inocencio Beltrán Marta Sandoval Torrientes Ruth Sáez Teresa Martín Pilar Tajada Alegre Belén Lorenzo María Teresa García Valero Isabel Jiménez Sansegundo Susana García‐de Cruz Sonsoles Garcinuño Miguel Ángel Sáiz Santiago Muñoz Isabel Fernández Helena Miriam Lorenzo Juanes María Reyes Vidal‐Acuña Luz María Moldes Noelia Calvo Matilde Trigo María José Gude Patricia Ordóñez Sandra Cortizo Miriam Blasco Mayra Sigcha Iker Falces Juan Carlos Galán Ana Arribi Roberto Alonso Asunción Iborra María Jesús del Amor Espín Eva Cascales Cayetano Pérez Pablo Fernández María Dolores Navarro María Luz Nuñez Jorge Galán Ros Luis Javier Gil‐Gallardo Ana Miqueleiz Gabriel Reina Luis Elorduy Mikele Macho Carmen Gómez Paloma Liendo Yolanda Salicio Antonio Aguilera Federico García Ana Alberola Adolfo de Salazar Ana Fuentes Raquel Carracedo Marta Illescas‐López María del Carmen Rodríguez Baños Carolina Freyre Berta Becerril Isabel Viciana Inmaculada López‐Rodríguez Natalia Montiel Ana María Domínguez Castaño María Pilar Luzón‐García Encarnación Ramírez Arellano Carmen Liébana‐Martos Francisco Franco Álvarez de Luna María del Carmen Lozano Begoña Palop Antonio Sampedro Ana Belén Pérez Sonia Algarate Susana Rojo Alba Pablo Fraile Dolores Ocete María Jesús Alcaraz Juan Carlos Rodríguez Francisco Javier Hernández‐Felices Olalla Martínez Victoria Domínguez Nieves Orta Dolores Gómez Carmen Cortell Jorge Camacho Susana Sabater Luis Ángel Iglesias Sánchez Yasmina Martín Aldara Vallejo Lourdes Molina María Aroca Beatriz Castro Magdalena Lara María José Pena Ana Rodríguez‐Fernández Alejandro González Praetorius José Joaquín Blas Alicia Beteta César Gómez María José Rodríguez Soledad Illescas Melanie Abreu Julio García Díez Inocencio Beltrán Marta Sandoval Torrientes Ruth Sáez Teresa Martín Pilar Tajada Alegre Belén Lorenzo María Teresa García Valero Isabel Jiménez Sansegundo Susana García‐de Cruz Sonsoles Garcinuño Miguel Ángel Sáiz Santiago Muñoz Isabel Fernández Helena Miriam Lorenzo Juanes María Reyes Vidal‐Acuña Luz María Moldes Noelia Calvo Matilde Trigo María José Gude Patricia Ordóñez Sandra Cortizo Miriam Blasco Mayra Sigcha Iker Falces Juan Carlos Galán Ana Arribi Roberto Alonso Asunción Iborra María Jesús del Amor Espín Eva Cascales Cayetano Pérez Pablo Fernández María Dolores Navarro María Luz Nuñez Jorge Galán Ros Luis Javier Gil‐Gallardo Ana Miqueleiz Gabriel Reina Luis Elorduy Mikele Macho Carmen Gómez Paloma Liendo Yolanda Salicio Antonio Aguilera Federico García |
| collection | Wiley Open Access |
| contents | Nationwide Implementation of Double Reflex Testing for Hepatitis Delta in Spain: Results From the Retrospective Phase of the Spain‐DDR Study Ana Alberola Adolfo de Salazar Ana Fuentes Raquel Carracedo Marta Illescas‐López María del Carmen Rodríguez Baños Carolina Freyre Berta Becerril Isabel Viciana Inmaculada López‐Rodríguez Natalia Montiel Ana María Domínguez Castaño María Pilar Luzón‐García Encarnación Ramírez Arellano Carmen Liébana‐Martos Francisco Franco Álvarez de Luna María del Carmen Lozano Begoña Palop Antonio Sampedro Ana Belén Pérez Sonia Algarate Susana Rojo Alba Pablo Fraile Dolores Ocete María Jesús Alcaraz Juan Carlos Rodríguez Francisco Javier Hernández‐Felices Olalla Martínez Victoria Domínguez Nieves Orta Dolores Gómez Carmen Cortell Jorge Camacho Susana Sabater Luis Ángel Iglesias Sánchez Yasmina Martín Aldara Vallejo Lourdes Molina María Aroca Beatriz Castro Magdalena Lara María José Pena Ana Rodríguez‐Fernández Alejandro González Praetorius José Joaquín Blas Alicia Beteta César Gómez María José Rodríguez Soledad Illescas Melanie Abreu Julio García Díez Inocencio Beltrán Marta Sandoval Torrientes Ruth Sáez Teresa Martín Pilar Tajada Alegre Belén Lorenzo María Teresa García Valero Isabel Jiménez Sansegundo Susana García‐de Cruz Sonsoles Garcinuño Miguel Ángel Sáiz Santiago Muñoz Isabel Fernández Helena Miriam Lorenzo Juanes María Reyes Vidal‐Acuña Luz María Moldes Noelia Calvo Matilde Trigo María José Gude Patricia Ordóñez Sandra Cortizo Miriam Blasco Mayra Sigcha Iker Falces Juan Carlos Galán Ana Arribi Roberto Alonso Asunción Iborra María Jesús del Amor Espín Eva Cascales Cayetano Pérez Pablo Fernández María Dolores Navarro María Luz Nuñez Jorge Galán Ros Luis Javier Gil‐Gallardo Ana Miqueleiz Gabriel Reina Luis Elorduy Mikele Macho Carmen Gómez Paloma Liendo Yolanda Salicio Antonio Aguilera Federico García Alimentary Pharmacology & Therapeutics ABSTRACT Background Hepatitis delta virus accelerates liver disease progression in chronic hepatitis B, yet remains underdiagnosed. Guidelines recommend double reflex diagnostic testing with antibody testing followed by viral load testing, but uptake remains inconsistent. Aims To evaluate double reflex diagnostic implementation in Spain during the retrospective phase of the Spain Double Reflex Diagnostic study. Methods Nationwide, multicenter retrospective analysis of individuals positive for hepatitis B surface antigen (2022–2024) from 80 centers. Laboratory data included hepatitis B surface antigen, hepatitis delta virus antibody and hepatitis delta virus viral load. Uptake rates, hepatitis delta virus antibody positivity, viral load confirmation and viral load‐confirmed prevalence were calculated with 95% confidence intervals. Results Among 65,763 individuals positive for hepatitis B surface antigen, hepatitis delta virus antibody testing uptake increased from 55.1% (54.4–55.8) in 2022 ( n = 18,986) to 72.5% (71.9–73.1) in 2023 ( n = 22,463) and 85.8% (85.1–86.4) in 2024 ( n = 24,314; p < 0.0001). Antibody positivity remained stable (5.6%, 4.9%, 5.3%). Viral load confirmation among antibody‐positive patients improved from 72.6% in 2022 to 90.8% in 2023 and 91.0% in 2024. Viral load‐confirmed prevalence among antibody‐positive individuals was 40.3% in 2022, 31.6% in 2023, and 30.1% in 2024. Regional heterogeneity was marked, with several autonomous communities achieving near‐universal uptake (> 95%). Conclusion Between 2022 and 2024, double reflex diagnostic implementation expanded rapidly, demonstrating national feasibility and describing hepatitis D virus seroprevalence. However, regional inequities persist. Sustained uptake will require standardised reflex protocols, harmonization of viral load assays and continuous training to reduce underdiagnosis and improve care of coinfected patients. 10.1111/apt.70543 http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| doi_str_mv | 10.1111/apt.70543 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_apt_70543 |
| institution | Wiley Open Access |
| license_str_mv | http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| publishDate | 2026 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Nationwide Implementation of Double Reflex Testing for Hepatitis Delta in Spain: Results From the Retrospective Phase of the Spain‐DDR Study Ana Alberola Adolfo de Salazar Ana Fuentes Raquel Carracedo Marta Illescas‐López María del Carmen Rodríguez Baños Carolina Freyre Berta Becerril Isabel Viciana Inmaculada López‐Rodríguez Natalia Montiel Ana María Domínguez Castaño María Pilar Luzón‐García Encarnación Ramírez Arellano Carmen Liébana‐Martos Francisco Franco Álvarez de Luna María del Carmen Lozano Begoña Palop Antonio Sampedro Ana Belén Pérez Sonia Algarate Susana Rojo Alba Pablo Fraile Dolores Ocete María Jesús Alcaraz Juan Carlos Rodríguez Francisco Javier Hernández‐Felices Olalla Martínez Victoria Domínguez Nieves Orta Dolores Gómez Carmen Cortell Jorge Camacho Susana Sabater Luis Ángel Iglesias Sánchez Yasmina Martín Aldara Vallejo Lourdes Molina María Aroca Beatriz Castro Magdalena Lara María José Pena Ana Rodríguez‐Fernández Alejandro González Praetorius José Joaquín Blas Alicia Beteta César Gómez María José Rodríguez Soledad Illescas Melanie Abreu Julio García Díez Inocencio Beltrán Marta Sandoval Torrientes Ruth Sáez Teresa Martín Pilar Tajada Alegre Belén Lorenzo María Teresa García Valero Isabel Jiménez Sansegundo Susana García‐de Cruz Sonsoles Garcinuño Miguel Ángel Sáiz Santiago Muñoz Isabel Fernández Helena Miriam Lorenzo Juanes María Reyes Vidal‐Acuña Luz María Moldes Noelia Calvo Matilde Trigo María José Gude Patricia Ordóñez Sandra Cortizo Miriam Blasco Mayra Sigcha Iker Falces Juan Carlos Galán Ana Arribi Roberto Alonso Asunción Iborra María Jesús del Amor Espín Eva Cascales Cayetano Pérez Pablo Fernández María Dolores Navarro María Luz Nuñez Jorge Galán Ros Luis Javier Gil‐Gallardo Ana Miqueleiz Gabriel Reina Luis Elorduy Mikele Macho Carmen Gómez Paloma Liendo Yolanda Salicio Antonio Aguilera Federico García Alimentary Pharmacology & Therapeutics Nationwide Implementation of Double Reflex Testing for Hepatitis Delta in Spain: Results From the Retrospective Phase of the Spain‐DDR Study Ana Alberola Adolfo de Salazar Ana Fuentes Raquel Carracedo Marta Illescas‐López María del Carmen Rodríguez Baños Carolina Freyre Berta Becerril Isabel Viciana Inmaculada López‐Rodríguez Natalia Montiel Ana María Domínguez Castaño María Pilar Luzón‐García Encarnación Ramírez Arellano Carmen Liébana‐Martos Francisco Franco Álvarez de Luna María del Carmen Lozano Begoña Palop Antonio Sampedro Ana Belén Pérez Sonia Algarate Susana Rojo Alba Pablo Fraile Dolores Ocete María Jesús Alcaraz Juan Carlos Rodríguez Francisco Javier Hernández‐Felices Olalla Martínez Victoria Domínguez Nieves Orta Dolores Gómez Carmen Cortell Jorge Camacho Susana Sabater Luis Ángel Iglesias Sánchez Yasmina Martín Aldara Vallejo Lourdes Molina María Aroca Beatriz Castro Magdalena Lara María José Pena Ana Rodríguez‐Fernández Alejandro González Praetorius José Joaquín Blas Alicia Beteta César Gómez María José Rodríguez Soledad Illescas Melanie Abreu Julio García Díez Inocencio Beltrán Marta Sandoval Torrientes Ruth Sáez Teresa Martín Pilar Tajada Alegre Belén Lorenzo María Teresa García Valero Isabel Jiménez Sansegundo Susana García‐de Cruz Sonsoles Garcinuño Miguel Ángel Sáiz Santiago Muñoz Isabel Fernández Helena Miriam Lorenzo Juanes María Reyes Vidal‐Acuña Luz María Moldes Noelia Calvo Matilde Trigo María José Gude Patricia Ordóñez Sandra Cortizo Miriam Blasco Mayra Sigcha Iker Falces Juan Carlos Galán Ana Arribi Roberto Alonso Asunción Iborra María Jesús del Amor Espín Eva Cascales Cayetano Pérez Pablo Fernández María Dolores Navarro María Luz Nuñez Jorge Galán Ros Luis Javier Gil‐Gallardo Ana Miqueleiz Gabriel Reina Luis Elorduy Mikele Macho Carmen Gómez Paloma Liendo Yolanda Salicio Antonio Aguilera Federico García Alimentary Pharmacology & Therapeutics ABSTRACT Background Hepatitis delta virus accelerates liver disease progression in chronic hepatitis B, yet remains underdiagnosed. Guidelines recommend double reflex diagnostic testing with antibody testing followed by viral load testing, but uptake remains inconsistent. Aims To evaluate double reflex diagnostic implementation in Spain during the retrospective phase of the Spain Double Reflex Diagnostic study. Methods Nationwide, multicenter retrospective analysis of individuals positive for hepatitis B surface antigen (2022–2024) from 80 centers. Laboratory data included hepatitis B surface antigen, hepatitis delta virus antibody and hepatitis delta virus viral load. Uptake rates, hepatitis delta virus antibody positivity, viral load confirmation and viral load‐confirmed prevalence were calculated with 95% confidence intervals. Results Among 65,763 individuals positive for hepatitis B surface antigen, hepatitis delta virus antibody testing uptake increased from 55.1% (54.4–55.8) in 2022 ( n = 18,986) to 72.5% (71.9–73.1) in 2023 ( n = 22,463) and 85.8% (85.1–86.4) in 2024 ( n = 24,314; p < 0.0001). Antibody positivity remained stable (5.6%, 4.9%, 5.3%). Viral load confirmation among antibody‐positive patients improved from 72.6% in 2022 to 90.8% in 2023 and 91.0% in 2024. Viral load‐confirmed prevalence among antibody‐positive individuals was 40.3% in 2022, 31.6% in 2023, and 30.1% in 2024. Regional heterogeneity was marked, with several autonomous communities achieving near‐universal uptake (> 95%). Conclusion Between 2022 and 2024, double reflex diagnostic implementation expanded rapidly, demonstrating national feasibility and describing hepatitis D virus seroprevalence. However, regional inequities persist. Sustained uptake will require standardised reflex protocols, harmonization of viral load assays and continuous training to reduce underdiagnosis and improve care of coinfected patients. 10.1111/apt.70543 http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| title | Nationwide Implementation of Double Reflex Testing for Hepatitis Delta in Spain: Results From the Retrospective Phase of the Spain‐DDR Study |
| topic | Alimentary Pharmacology & Therapeutics |
| url | https://onlinelibrary.wiley.com/doi/10.1111/apt.70543 |