Criteria

METAVIR[50]

Meta-analysis of histological data in viral hepatitis (METAVIR) is a histological scoring system used to assess degree of inflammation and stage of liver disease in chronic hepatitis. The grade indicates the activity or degree of inflammation and the stage represents the amount of fibrosis or scarring.

Activity grade:

  • A0: no activity

  • A1: mild activity

  • A2: moderate activity

  • A3: severe activity

Fibrosis stage:

  • F0: no fibrosis

  • F1: portal fibrosis without septa

  • F2: portal fibrosis with few septa

  • F3: numerous septa without cirrhosis

  • F4: cirrhosis

Ishak score[51]

The Ishak system assesses fibrosis in seven categories, ranging from normal to cirrhosis.

[Figure caption and citation for the preceding image starts]: Stage component of the Ishak systemAdapted from Standish RA et al. Gut 2006 Apr;55(4):569-78 and Ishak K et al. J Hepatol 1995 Jun;22(5):696-9; used with permission [Citation ends].com.bmj.content.model.Caption@6db901bd

Centers for Disease Control and Prevention (CDC): hepatitis D virus 2025 case definition[52]

Laboratory criteria

  • Confirmatory laboratory evidence: detection of hepatitis D virus (HDV) RNA by nucleic acid test (qualitative, quantitative, or genotype testing).

  • Presumptive laboratory evidence: total antibody to HDV (total anti-HDV) is reactive.

Case classification

  • Probable: meets presumptive laboratory evidence.

  • Confirmed: meets confirmatory laboratory evidence.

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