New Insights on the Burden of Hepatitis Delta, With Chari Cohen, DrPH, MPH – HCPLive

Report on the Quality of Life Impact of Hepatitis Delta Virus (HDV) and its Implications for Sustainable Development Goals

1.0 Introduction

New research presented at the American Association for the Study of Liver Diseases (AASLD) The Liver Meeting 2025 provides critical data on the quality of life (QoL) impact of Hepatitis Delta Virus (HDV). The findings highlight significant barriers to achieving key Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being). The report underscores an urgent need for enhanced screening, increased awareness, and holistic patient care to mitigate the disease’s substantial health, social, and economic burdens.

2.0 Alignment with SDG 3: Good Health and Well-being

The study’s findings directly address the challenges in meeting SDG Target 3.3, which aims to end the epidemic of hepatitis by 2030. HDV represents a severe form of viral hepatitis, recently classified as carcinogenic to humans, which complicates efforts to combat the disease.

• Increased Disease Burden: HDV requires a co-infection with Hepatitis B Virus (HBV), leading to a greater disease burden and more severe health outcomes. This co-infection is linked to a higher risk of:
  • Liver decompensation
  • Hepatocellular carcinoma
  • Liver transplantation
  • Death
• Elevated Cancer Risk: Patients with HBV/HDV co-infection face a 2-6 times higher risk of liver cancer compared to those with HBV monoinfection, directly challenging public health goals.
• Mental Health Impact: In alignment with SDG Target 3.4 (promote mental health and well-being), the research identified significant mental health challenges among patients, including frequent anxiety, depression, despair, and fear, which are often overlooked in clinical care.

3.0 Socioeconomic Impacts and Relation to SDGs 1, 8, and 10

The report demonstrates that the impact of HDV extends beyond health, affecting socioeconomic stability and exacerbating inequalities, thereby hindering progress on multiple SDGs.

• SDG 1 (No Poverty) & SDG 8 (Decent Work and Economic Growth): Qualitative interviews revealed significant financial challenges and reduced job performance among patients. The physical and mental symptoms of HDV impede patients’ ability to maintain productive employment, threatening their economic stability.
• SDG 10 (Reduced Inequalities): The study, which included participants from 25 countries, highlights the global and unequal burden of HDV. Limited access to affordable screening, testing, and treatment, coupled with social stigma, deepens health disparities both within and between nations.

4.0 Research Methodology

The findings are based on a mixed-methods approach to gather comprehensive patient-reported outcomes.

1. Quantitative Survey: A survey was distributed via online platforms to 72 respondents from 25 countries, with the majority from Pakistan, the United States, and the Philippines. 71% of respondents were male.
2. Qualitative Interviews: In-depth virtual interviews were conducted with 13 participants to explore the nuanced impacts of living with HDV.

5.0 Key Findings on Patient-Reported Outcomes

5.1 Physical Symptom Burden

Contrary to the misconception of HDV as a “silent disease,” a majority of patients (70%) reported experiencing symptoms, even without clinical evidence of advanced liver damage. The most common symptoms included:

• Fatigue (69%)
• Abdominal pain (41%)
• Muscle or joint pain (38%)
• Loss of appetite (38%)

Furthermore, 27% of participants rated their symptom severity as a 7 on a 10-point scale, underscoring the significant physical burden of the disease.

5.2 Psychosocial and Healthcare Challenges

Qualitative data revealed profound impacts on patients’ daily lives and interactions with the healthcare system.

• Lifestyle and Social Impact: Patients reported difficulty concentrating and concerns about social stigma.
• Mental Health: Common themes included anxiety, depression, and fear related to their diagnosis and future.
• Healthcare System Failures: Participants noted strained communication with providers and limited access to specialized care and treatment, indicating a gap in delivering effective health services.

6.0 Recommendations for Policy and Practice to Advance SDGs

To address the challenges posed by HDV and accelerate progress towards the SDGs, the following actions are recommended:

1. Improve the Care Cascade: Strengthen health systems to ensure everyone living with HDV is diagnosed, linked to care, and receives treatment, directly contributing to SDG 3.
2. Ensure Universal Access to Screening: Implement broader access to affordable screening and testing for HDV. This requires moving beyond risk-based screening models that are difficult to implement and can perpetuate inequalities (SDG 10).
3. Raise Public and Provider Awareness: Develop targeted educational campaigns to correct misconceptions about HDV, reduce stigma, and improve clinical recognition of the disease’s impact.
4. Integrate Holistic Care: Incorporate mental, social, and financial support into the standard of care for HDV patients to address the full disease burden and support progress on SDGs 1, 3, and 8.
5. Incorporate Patient-Reported Outcomes: Systematically integrate QoL assessments into the clinical management of HDV to ensure that healthcare is responsive to patient needs and truly promotes well-being.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The primary SDG addressed in the article is SDG 3: Good Health and Well-being. The entire article focuses on the health impacts of Hepatitis Delta Virus (HDV), a communicable disease, and its effects on patients’ physical and mental health.

• Direct Connection: The article discusses the disease burden of HDV, its link to severe liver outcomes like cancer, the physical symptoms experienced by patients (fatigue, pain), and the significant mental health impacts, including anxiety and depression.
• Broader Implications: It also touches upon the need for universal access to healthcare services, including screening, testing, and treatment, which is a core component of SDG 3. The discussion of financial challenges and reduced job performance also connects the health issue to overall well-being.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the article’s content, the following specific targets under SDG 3 can be identified:

1. Target 3.3: End epidemics of communicable diseases.
   • This target explicitly mentions the goal to “combat hepatitis.” The article is entirely focused on understanding and improving care for Hepatitis Delta (HDV), a communicable disease. It calls for broader screening, increased awareness, and better diagnosis to manage the disease.
2. Target 3.4: Reduce mortality from non-communicable diseases and promote mental health.
   • The article connects HDV infection to a “higher risk of severe liver-related outcomes,” including hepatocellular carcinoma (liver cancer), which is a non-communicable disease. Furthermore, it heavily emphasizes the “mental impacts, including frequent anxiety, depression, despair, and fear,” and calls for the “holistic integration of mental… support into HDV care,” directly aligning with the promotion of mental health and well-being.
3. Target 3.8: Achieve universal health coverage (UHC).
   • The article highlights significant barriers to healthcare that contradict the principles of UHC. It points out “limited access to treatment and care” and explicitly calls for “access to affordable screening and testing for hepatitis delta.” The mention of “strained communication with providers” and the need to improve the “entire care cascade” also relates to the quality and accessibility of essential health services.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article mentions and implies several indicators that can be used to measure progress:

• For Target 3.3 (Combat Hepatitis):
  • Screening and Diagnosis Rates: The call for “broader screening” and making sure “people with hepatitis delta are diagnosed” implies that the rate of screening and diagnosis is a key indicator of progress.
  • Treatment Coverage: The survey data stating that “65% [of respondents] for HDV” had been prescribed treatment serves as a direct indicator of treatment coverage for the diagnosed population.
  • Public and Provider Awareness Levels: The article notes an “utter lack of awareness” and “misconceptions” among providers. Measuring changes in awareness through surveys would be an implied indicator.
• For Target 3.4 (Promote Mental Health):
  • Prevalence of Symptoms: The survey finding that 70% of patients experienced symptoms like fatigue (69%) and pain (41%) is a measure of the disease’s physical burden.
  • Patient-Reported Quality of Life (QoL): The entire study is centered on “Understanding Quality of Life Impacts.” The call to incorporate “patient-reported outcomes and quality of life into the clinical care journey” suggests using QoL scores as a key indicator.
  • Prevalence of Mental Health Issues: The identification of “frequent anxiety, depression, despair, and fear” in qualitative interviews implies that the prevalence of these conditions among HDV patients is a critical indicator of their well-being.
• For Target 3.8 (Universal Health Coverage):
  • Access to Services: The mention of “limited access to treatment and care” points to the proportion of the patient population able to access necessary health services as a key indicator.
  • Affordability of Services: The specific call for “access to affordable screening and testing” implies that the cost of these services and the financial burden on patients are measurable indicators.

4. Summary Table of SDGs, Targets, and Indicators

Source: hcplive.com