Hepatitis B treatment and care in the UK need to evolve to keep pace with the global epidemic Hepatitis B >
Michael Carter
Published: 09 January 2013
“Persistent HBV [hepatitis B virus]infection has changed its face in the UK,” research published in the onlineedition of Clinical Infectious Diseasesshows. The study found considerable diversity in viral genotype and patientethnicity, and that only one in three patients were taking therapy. There wasextensive use of non-recommended treatment and approximately a third of treatedpatients had drug-resistant virus. Few people had been tested forco-infections such as HIV. The investigators believe their findings haveimportant implications for those planning hepatitis B services and show the“globilisation” of the epidemic.
Persistent hepatitis B virus infection isassociated with progressive liver disease and a high risk of hepatocellularcarcinoma.
There are ten known hepatitis B genotypes,each of which has a specific geographical distribution. It is possible thatmigration has altered the ethnic populations affected by hepatitis B in the UKand the genetic diversity of the virus.
Investigators therefore obtainedinformation on a snapshot sample of people attending specialist hepatologyclinics in the UK. Demographic, clinical and laboratory data were collected.
A total of 698 people who receivedcare for chronic hepatitis B infection between 2007 and 2009 were recruited.
“This national cross-sectional study ofpersistent HBV infection represents a snapshot of current disease burden ofpatients attending…liver clinics in the UK,” write the authors. “We believethat the patients in this study are likely representative of the clinicpopulation from which they are drawn and that the study providescharacterisation of both patients and viruses.”
Most of the patients were men (61%), whowere significantly older than female patients (mean age 45 vs 38 years, p <0.001). Participants originated from 61 different countries and all the majorethnicities were represented, the largest being East and South East Asian(37%), White (25%), South Asian (20%) and Black African (15%).
Overall, 80% of patients were born outsidethe UK.
Consumption of alcohol is known toaccelerate liver damage in the context of hepatitis B infection, and a third ofpatients were recorded as regularly drinking alcohol.
Just over a fifth of patients were HBeAgseropositive.
Differences were apparent in the treatmentand care of men and women. Men were significantly more likely than women tohave undergone a liver biopsy (53 vs 23%, p < 0.0001) and to be takingantiviral treatment (45 vs 17%, p 0.0001). A fifth of patients who hadundergone a liver biopsy were found to have cirrhosis. Rates of cirrhosis weresignificantly higher in men than women (24 vs 8%, p = 0.006). There were tencases of hepatocellular carcinoma, nine of which were in men.
A total of eight hepatitis B genotypes wereidentified. Genotype D was the most common, representing 31% of all infections.Genotypes A, B and C were each found in approximately a fifth of patients.
There was a strong association betweengenotype and e antigen status. Patients with genotype A and C viruses weresignificantly more likely to be e antigen positive (30 and 41% respectively; p= 0.001).
Only a third of patients were takinghepatitis B therapy, with just 18% taking recommended first-line treatment. Approximatelya third (31%) of those on treatment were taking lamivudine monotherapy. Theinvestigators found this “disconcerting”, noting that this treatment strategyis not recommended and “associated with rapid development of resistance, severehepatic flares and decompensation as well as limiting future treatmentoptions.”
Drug-resistant hepatitis B was detected in27% of patients who had undergone treatment.
Some 16% of patients not currently ontherapy had hepatitis B DNA above 2000 iu/ml and ALT levels above the upperlimit of normal, “indicating a need for treatment.”
Guidelines recommend that hepatitisB-infected patients should be tested for other viral co-infections. However,only 31% of patients had documented HIV test results. Nine patients were knownto be co-infected with HIV. Approximately half the patients had been screenedfor hepatitis C, and seven patients had antibodies for this infection. Only athird of patients had been tested for hepatitis delta, which “is associatedwith a more rapidly progressive clinical course” of hepatitis B infection.
“Those planning, commissioning and managinghepatology services must now take host virus diversity into account,” concludethe authors. “Optimal management requires awareness of the variable patterns ofchronic HBV in countries of origin.”
Reference Tedder RS et al. The diversity and management of chronic hepatitis B virus infections inthe UK – a wake up call. Clin Infect Dis, online edition, 2013.
大约有三分之一（31％）的治疗上服用拉米夫定单药治疗。研究者觉得，这个“令人不安”，并指出不建议这种治疗策略“快速发展耐药性，严重肝爆发(flare)和失代偿，以及限制未来的治疗方案。”
Approximately a third (31%) of those on treatment were taking lamivudine monotherapy. The investigators found this “disconcerting”, noting that this treatment strategy is not recommended and “associated with rapid development of resistance, severe hepatic flares and decompensation as well as limiting future treatmentoptions.”