Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2018; 24(11): 1216-1227
Published online Mar 21, 2018. doi: 10.3748/wjg.v24.i11.1216
Differing profiles of people diagnosed with acute and chronic hepatitis B virus infection in British Columbia, Canada
Mawuena Binka, Zahid A Butt, Stanley Wong, Mei Chong, Jane A Buxton, Nuria Chapinal, Amanda Yu, Maria Alvarez, Maryam Darvishian, Jason Wong, Gina McGowan, Mikhail Torban, Mark Gilbert, Mark Tyndall, Mel Krajden, Naveed Z Janjua
Mawuena Binka, Zahid A Butt, Stanley Wong, Mei Chong, Jane A Buxton, Nuria Chapinal, Amanda Yu, Maria Alvarez, Maryam Darvishian, Jason Wong, Mark Gilbert, Mark Tyndall, Mel Krajden, Naveed Z Janjua, British Columbia Centre for Disease Control, Vancouver BC V5Z4R4, Canada
Mawuena Binka, Zahid A Butt, Stanley Wong, Jane A Buxton, Maryam Darvishian, Jason Wong, Mark Gilbert, Mark Tyndall, Naveed Z Janjua, School of Population and Public Health, University of British Columbia, Vancouver BC V6T1Z3, Canada
Gina McGowan, Mikhail Torban, Division of Population and Public Health, Ministry of Health, Victoria BC V8W9P1, Canada
Mel Krajden, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver BC V6T1Z2, Canada
Author contributions: Janjua NZ conceptualized the study; Janjua NZ, Chong M and Wong S contributed to study design; Binka M and Janjua NZ contributed to data analysis and interpretation, and writing of article; Butt ZA, Wong S, Chong M, Chapinal N, Yu A, Alvarez M, McGowan G, Torban M, Darvishian M and Janjua NZ contributed to data acquisition; Butt ZA, Buxton JA, Wong J, McGowan G, Torban M, Gilbert M, Tyndall M, Krajden M and Janjua NZ contributed to editing, reviewing and final approval of article.
Supported by the BC Centre for Disease Control and the Canadian Institutes of Health Research, No. NHC–142832 and No. PHE-141773.
Institutional review board statement: The Behavioral Research Ethics Board of the University of British Columbia approved this study (H14-01649).
Conflict-of-interest statement: Mel Krajden reports receiving grant funding via his institution from Roche Molecular Systems, Boehringer Ingelheim, Merck, Siemens Healthcare Diagnostics and Hologic Inc. No other authors have conflicts of interest to declare.
Data sharing statement: Data are available from the BC Centre for Disease Control Institutional Data Access for researchers who meet the criteria for access to confidential data.
STROBE statement: The manuscript was prepared according to the STROBE Statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Naveed Z Janjua, MBBS, MSc, DrPH, BC Centre for Disease Control, 655 West 12th Avenue, Vancouver BC V5Z4R4, Canada. naveed.janjua@bccdc.ca
Telephone: +1-604-7072514 Fax: +1-604-7072401
Received: January 13, 2018
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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.