Published online Mar 21, 2018. doi: 10.3748/wjg.v24.i11.1216
Peer-review started: January 13, 2018
First decision: February 5, 2018
Revised: February 21, 2018
Accepted: March 3, 2018
Article in press: March 3, 2018
Published online: March 21, 2018
Processing time: 62 Days and 5.9 Hours
Hepatitis B virus (HBV) affects approximately 200000 Canadians and 257 million people worldwide. In many developed countries, a relatively larger number of people are diagnosed with chronic HBV compared to acute HBV, each year. Chronic HBV infection is associated with 66% of the 1.34 million viral hepatitis-related deaths reported worldwide. It is responsible for a substantial disease burden from liver cancer and end-stage liver disease.
Data from Canada, the United States and other developed countries indicate that most chronic HBV infections are diagnosed among immigrants from HBV-endemic Asia-Pacific countries, while acute infections are predominant among White individuals. Persons diagnosed with acute and chronic HBV infections may differ with respect to demographics and risk behavior. These distinctions may have implications for interventions targeted at either population. Additionally, 49% of persons with chronic HBV and decompensated cirrhosis and 46% of those with HCC in British Columbia (BC) were diagnosed late in the course of their infections. Therefore, establishing the characteristics of individuals who are more likely to be infected with HBV could enhance the planning of prevention and screening programs to further reduce late diagnoses within the province.
In this study, we describe the characteristics of individuals diagnosed with acute and chronic HBV infections and identify the factors associated with HBV infection within the BC Hepatitis Testers Cohort (BC-HTC). We are unaware of any study comparing large population level data for both acute and chronic HBV. Study findings should inform prevention and screening programs within BC.
We used data from the BC Hepatitis Testers Cohort (BC-HTC), which includes all individuals tested for HCV or HIV and those diagnosed with HBV or TB in BC since 1990. These data were integrated with prescription drug, medical visit, hospitalization and mortality data. HBV cases were classified as acute or chronic in accordance with provincial guidelines. We compared characteristics of individuals by HBV infection group (acute, chronic and negative). Factors associated with acute or chronic HBV infection were assessed with multivariable multinomial logistic regression models in comparison with the HBV negative group.
46498 of the 1058056 eligible BC-HTC participants were diagnosed with HBV infection; 95.7% with chronic infections at HBV diagnosis. Acute HBV infections, indicative of new transmission events, were diagnosed predominantly among males, persons aged between 25 and 34 years, White individuals, and socioeconomically disadvantaged persons. Problematic alcohol use, injection drug use, HIV and HCV co-infection were also common within this group. Individuals diagnosed with chronic HBV infection were predominantly older and East Asian. Additionally, substance use and HIV or HCV co-infection were relatively low within this group. Relative to Whites, East Asians had 12 times greater odds of being diagnosed with chronic HBV infection. These odds increased with increasing socioeconomic deprivation.
These findings highlight distinct risk patterns for individuals with acute and chronic HBV infections and underscore the need for different strategies to prevent, diagnose and treat HBV within these groups. Optimal care for acute HBV would require the integration of HBV prevention, screening, and treatment programs with programs for mental health, addiction and other blood-borne infections. Managing chronic HBV, on the other hand, may require screening programs focusing on at-risk ethnic groups, including foreign-born East and South Asians with low prevalence of traditional risk factors, for early diagnosis and treatment initiation.
We found clear differences in the characteristics of individuals diagnosed with acute and chronic HBV in BC. Consequently, we propose two distinct interventions for the management of acute and chronic HBV in the province: the integration of HBV-related public health programs with those of blood borne infection programs and mental health services to provide optimal care for populations at risk for acquiring acute HBV, and the implementation of targeted screening programs for early diagnosis among ethnic groups at risk for chronic HBV.