Dr Eid Mansour, General Manager, Gilead Sciences Middle East, examines the persistent underdiagnosis of Hepatitis Delta across the region, placing it within the wider burden of viral hepatitis B and C. Marking World Hepatitis Day, he analyses the clinical, cultural and systemic barriers delaying testing and treatment, and argues for routine screening, clinician education and stigma-free care pathways to ensure earlier diagnosis and improved long-term outcomes for co-infected patients.
Viral hepatitis is one of the world’s most significant public health challenges, and one of its quietest. Most people living with it have no idea. World Hepatitis Day, marked every year on July 28th, is a moment to change that, and this year’s theme, “Let’s Break It Down,” speaks directly to what is needed. Despite real progress in understanding and treating the disease, the barriers that stand between people and care in our region are not always clinical. They are cultural and systemic, and they are still being felt.
According to the World Health Organization, viral hepatitis B and C affect an estimated 240 million people globally, causing more than 1.3 million deaths every year. Across the Middle East, viral hepatitis continues to place a significant burden on individuals and healthcare systems alike. However, one form of the disease continues to receive far less attention than it deserves – Hepatitis Delta (HDV). Despite its severity, HDV remains underdiagnosed and too often overlooked in discussions around viral hepatitis. This World Hepatitis Day, breaking it down starts with breaking down the barriers that prevent people from accessing testing, treatment, and care.
Why Awareness Matters
Most people living with viral hepatitis have no symptoms in the early stages. There is no obvious sign that something is wrong, which means many people go for years, sometimes decades, without knowing they are infected. By the time symptoms do appear, the liver may already have sustained significant damage, increasing the risk of liver cancer and other serious complications.
For patients living with Hepatitis Delta, this challenge is even more acute. HDV can only infect people who are already living with hepatitis B, and co-infection with both viruses leads to faster liver disease progression and significantly worse outcomes compared to hepatitis B alone. Awareness of Hepatitis Delta remains low among both the public and many healthcare professionals, contributing to delays in diagnosis and care.
Social misconceptions and a lack of awareness about viral hepatitis can further discourage people from seeking testing and care. In many communities across the Middle East, concerns about how a diagnosis may be perceived can delay testing, even when services are available. Increasing public understanding of hepatitis is therefore an important step toward improving access to care.
For people living with hepatitis B, a Delta co-infection can add further complexity to an already challenging diagnosis. Ensuring access to clear and stigma-free information is therefore a vital part of effective care.
Breaking down the silence around Hepatitis Delta starts with investing in public education, training healthcare professionals to recognize and test for HDV, and making sure patients feel safe enough to seek care without fear.
The Importance of Early Diagnosis and Routine Screening
Early diagnosis is one of the most effective tools available when it comes to improving outcomes for people living with viral hepatitis. When the disease is caught before liver damage has occurred, the options available to patients are much broader, treatment is more effective, and the risk of serious long-term complications is significantly lower.
For hepatitis C, early diagnosis gives people the opportunity to benefit from treatments that achieve success rates of over 95%. For Hepatitis Delta, the urgency lies elsewhere. HDV co-infection can significantly accelerate liver disease progression, yet many people living with chronic hepatitis B experience no symptoms for years. Without routine testing for HDV, co-infection may remain undetected until significant liver damage has already occurred.
This is why routine and proactive screening matter. Consideration should be given to HDV testing at-risk populations, in accordance with local guidelines and clinical judgment. Healthcare professionals can help improve early diagnosis by considering comprehensive hepatitis testing where clinically appropriate and consistent with local standards of care. This can make a meaningful difference in ensuring more people are diagnosed early and linked to appropriate care.
Supporting the Patient
Getting a diagnosis is an important step, but it is not the end of the journey. For many patients, what comes after a positive hepatitis diagnosis is just as important as the diagnosis itself. Immediate care and consistent access to treatment are both critical to improving patient outcomes, and for patients living with Hepatitis Delta, that journey can be particularly complex.
Managing HDV requires ongoing monitoring with a clear and consistent care plan. Unlike hepatitis C, where a defined course of treatment can lead to a cure, hepatitis B and Delta require long-term management, which makes continuity of care a central part of the patient’s experience. Regular follow-up, access to antiviral therapy, and a healthcare provider who understands the full picture of a patient’s condition are vital to achieving better long-term outcomes.
Patients need to feel confident and supported when they engage with healthcare services. Building trust, providing clear information, and ensuring a positive patient experience are all important factors in helping people remain engaged in care over the long term. Healthcare institutions and professionals across the region play a vital role in creating environments that encourage patients to seek care early and maintain regular follow-up throughout their treatment journey.
There has been significant progress in hepatitis care in recent years across the Middle East. Advances in screening, diagnosis, treatment, and national elimination efforts have helped improve outcomes for millions of people and brought the goal of eliminating viral hepatitis closer to reality. The WHO Global Health Sector Strategy on Viral Hepatitis provides a clear framework for building this progress through stronger prevention, testing, diagnosis, treatment, and long-term care. Yet despite these advances, Hepatitis Delta continues to be overlooked, leaving many patients without the timely diagnosis and care they need. At Gilead Sciences, supporting progress across the wide spectrum of viral hepatitis, including Hepatitis Delta, is central to what we do.
Conclusion
“Let’s Break It Down” is a theme that calls on everyone involved in the hepatitis response to take practical action. It encourages healthcare professionals to make comprehensive hepatitis testing, including HDV where appropriate, a routine part of patient care. It also challenges health systems to identify and address gaps in screening and care, particularly for forms of hepatitis that continue to go undiagnosed. Finally, it reminds us all to recognize stigma as a real barrier to care, not only within communities, but within healthcare settings as well.
This World Hepatitis Day, breaking it down starts with making sure no form of this disease, and no patient living with it, is left behind.
