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

Research output: Contribution to journalArticle


  • 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
  • Mike Jacobs
  • Peter R Mills
  • David Mutimer
  • Stephen D Ryder
  • Andrew Bathgate
  • Hyder 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


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