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Abstract Details
The Diversity and Management of Chronic Hepatitis B Virus Infections in the UK - A Wake up Call
Tedder RS, Rodger AJ, Fries L, Ijaz S, Thursz M, Rosenberg W, Naoumov N, Banatvala J, Williams R, Dusheiko G, Chokshi S, Wong T, Rosenberg G, Moreea S, Bassendine M, Jacobs M, Mills PR, Mutimer D, Ryder S, Bathgate A, Hussaini H, Dillon J, Wright M, Bird G, Collier J, Anderson M, Johnson A; for the CUSHIB Study Group. Clin Infect Dis. 2012 Dec 7. [Epub ahead of print]
Source
MS-Colindale, Health Protection Agency, Colindale, London, UK.
Abstract
Background. Through migration, diversity of chronic hepatitis B virus (HBV) infection has changed which may impact on disease burden and control. We describe clinical and viral characteristics of chronic HBV in the UK.Methods. 698 individuals with chronic HBV infection were recruited from referral liver centres. Demographic, clinical, and laboratory data were collected.Results. 61% were male, 80% were non UK-born. Largest ethnicity was East/South East Asian (36%). 22% were HBeAg seropositive. 20.4% (59/289) had cirrhosis on liver biopsy and 10 (1.7%) had HCC. Genotype D was most common (31%) followed by A, C, B and E (20%, 20%, 19%, and 9%). Genotype was significantly associated with country of birth, length of time in UK, HBe status, precore and basal core promoter mutations. One third were on treatment with men independently more likely than women to be treated. Only 18% of those on treatment were on recommended first line therapies and 30% were on 3TC monotherapy. 27% of treated individuals had antiviral drug resistance. Testing for HIV, HCV and delta co-infections was low.Conclusions. We have 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 co-infections.