TY - JOUR
T1 - The diversity and management of chronic hepatitis B virus infections in the United Kingdom
T2 - a wake-up call
AU - Tedder, Richard S
AU - Rodger, Alison J
AU - Fries, Lori
AU - Ijaz, Samreen
AU - Thursz, Mark
AU - Rosenberg, William
AU - Naoumov, Nikolai
AU - Banatvala, Jangu
AU - Williams, Roger
AU - Dusheiko, Geoffrey
AU - Chokshi, Shilpa
AU - Wong, Terry
AU - Rosenberg, Gillian
AU - Moreea, Sulleman
AU - Bassendine, Margaret
AU - Jacobs, Michael
AU - Mills, Peter R
AU - Mutimer, David
AU - Ryder, Stephen D
AU - Bathgate, Andrew
AU - Hussaini, Hyder
AU - Dillon, John F
AU - Wright, Mark
AU - Bird, George
AU - Collier, Jane
AU - Anderson, Michael
AU - Johnson, Anne M
AU - Collaborative UK Study of Chronic Hepatitis B Infection (CUSHI-B) Study Group
PY - 2013/4
Y1 - 2013/4
N2 - 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.
AB - 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.
KW - Adult
KW - Carcinoma, Hepatocellular
KW - Cross-Sectional Studies
KW - Female
KW - Genotype
KW - Great Britain
KW - Hepatitis B virus
KW - Hepatitis B, Chronic
KW - Humans
KW - Liver Cirrhosis
KW - Male
KW - Middle Aged
KW - Prevalence
U2 - 10.1093/cid/cis1013
DO - 10.1093/cid/cis1013
M3 - Article
C2 - 23223601
SN - 1058-4838
VL - 56
SP - 951
EP - 960
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 7
ER -
