The diversity and management of chronic hepatitis B virus infections in the United Kingdom: a wake-up call

Richard S Tedder, Alison J Rodger, Lori Fries, Samreen Ijaz, Mark Thursz, William Rosenberg, Nikolai Naoumov, Jangu Banatvala, Roger Williams, Geoffrey Dusheiko, Shilpa Chokshi, Terry Wong, Gillian Rosenberg, Sulleman Moreea, Margaret Bassendine, Michael Jacobs, Peter R Mills, David Mutimer, Stephen D Ryder, Andrew BathgateHyder Hussaini, John F Dillon, Mark Wright, George Bird, Jane Collier, Michael Anderson, Anne M Johnson, Collaborative UK Study of Chronic Hepatitis B Infection (CUSHI-B) Study Group

Research output: Contribution to journalArticlepeer-review

27 Citations (Scopus)


BACKGROUND: Through migration, diversity of chronic hepatitis B virus (HBV) infection has changed, affecting disease burden and control. We describe clinical and viral characteristics of chronic HBV in the United Kingdom.

METHODS: A total of 698 individuals with chronic HBV infection were recruited from referral liver centers. Demographic, clinical, and laboratory data were collected.

RESULTS: Sixty-one percent of patients were male, 80% were not born in the United Kingdom, and the largest ethnicity was East/Southeast Asian (36%). Twenty-two percent were hepatitis B e antigen (HBeAg) seropositive; 20.4% (59/289) had cirrhosis and 10 (1.7%) had hepatocellular carcinoma. Genotype D was most common (31%) followed by A, C, B, and E (20%, 20%, 19%, and 9%, respectively). Genotype was significantly associated with country of birth, length of time in the United Kingdom, HBeAg status, and precore and basal core promoter mutations. One-third were on treatment, with men independently more likely to be treated. Only 18% of those on treatment were on recommended first-line therapies, and 30% were on lamivudine monotherapy. Among treated individuals, 27% had antiviral drug resistance. Testing rates for human immunodeficiency virus, hepatitis C virus, and delta coinfections were low.

CONCLUSIONS: We demonstrated diversity of chronic HBV infections in UK patients, suggesting that optimal management requires awareness of the variable patterns of chronic HBV in countries of origin. We also found less-than-optimal clinical management practices, possible gender-based treatment bias, and the need to improve testing for coinfections.

Original languageEnglish
Pages (from-to)951-60
Number of pages10
JournalClinical Infectious Diseases
Issue number7
Publication statusPublished - Apr 2013


  • Adult
  • Carcinoma, Hepatocellular
  • Cross-Sectional Studies
  • Female
  • Genotype
  • Great Britain
  • Hepatitis B virus
  • Hepatitis B, Chronic
  • Humans
  • Liver Cirrhosis
  • Male
  • Middle Aged
  • Prevalence


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