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 - for the Collaborative UK Study of Chronic Hepatitis B Infection (CUSHI-B) Study Group
PY - 2013/1/10
Y1 - 2013/1/10
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.
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 -
