在英国的B型肝炎的治疗和护理需要发展，以跟上全球流行的

StephenW

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.

StephenW

在英国的B型肝炎的治疗和护理需要发展，以跟上全球流行的
B型肝炎>
迈克尔·卡特
出版日期：2013年1月9日

“持久性HBV B型肝炎病毒感染在英国，已经改变了它的脸”的研究发表在在线版的临床感染性疾病显示。研究发现，相当大的差异，在病毒基因型和病人的种族，只有三分之一的患者服用治疗。进行了广泛的使用非推荐的治疗和药物抗病毒治疗的患者约三分之一。很少人已经进行过合作，如HIV感染。研究人员认为，他们的发现具有重要意义，为那些计划B型肝炎的服务，并显示疫情的的“globilisation”。

持续性乙肝病毒感染与进展性肝病，肝癌的高风险。

有10的公知的B型肝炎基因型，其中每一个具有一个特定的地理分布。这是可能的迁移已经改变了在英国的B型肝炎的病毒的遗传多样性影响的少数民族人口。

研究人员因此获得的信息快照样的人在英国就读专业的肝病诊疗。人口学，临床和实验室数据收集。

总共有698人接受治疗的慢性乙肝病毒感染在2007年和2009年之间被招募。

“这个国家的横断面研究HBV持续感染求诊的患者肝诊所在英国目前的疾病负担的快照，”写作者。 “我们相信，在这项研究中，患者有可能代表的诊所人口从他们绘制的研究提供了患者和病毒的特性。”

大多数患者是男性（61％），明显岁以上女性患者（平均年龄45和38岁，P <0.001）。参加者来自61个不同国家的起源和所有的主要种族的代表出席了会议，其中最大的是东亚和东南亚（37％），白色（25％），南亚（20％）和黑非洲（15％）。

总体而言，80％的患者在英国以外出生的。

食用酒精是众所周知的B型肝炎病毒感染的背景下，加速肝功能损害和经常饮酒的患者的三分之一。

超过五分之一的患者为HBeAg阳性。

差异是明显的，在治疗和护理的男性和女性。男性比女性更容易经历了肝活检（53对23％，P <0.0001），并采取抗病毒治疗（45对17％，P <0.0001）。谁经历了肝活检有五分之一的患者被发现有肝硬化。肝硬化率明显较高，男性多于女性（24比8％，P = 0.006）。有10例肝细胞癌，其中9个是在男性。

一共有8个B型肝炎基因型进行了鉴定。 D型是最常见的，占31％的感染。基因型A，B，C组各约五分之一的患者。

基因型及e抗原状态之间有很强的关联。 A基因型患者和丙肝病毒，更可能是e抗原阳性（30和41％，P = 0.001）。

只有三分之一的患者服用乙肝治疗药物，只有18％建议的第一线治疗。大约有三分之一（31％）的治疗上服用拉米夫定单药治疗。研究者发现，这个“令人不安”，并指出不建议这种治疗策略“与快速发展的阻力，严重肝耀斑和失代偿，以及限制未来的治疗方案。”

在27％的患者接受治疗耐药的乙肝检测。

高于2000 IU / ml和ALT水平高于正常上限的，目前治疗的患者中，约有16％的乙肝DNA“，表示需要治疗。”

指南建议，应检测其他病毒合并感染B型肝炎病毒感染的患者。然而，只有31％的患者有记录的HIV检测结果。 9例患者共同感染了艾滋病毒。大约有一半的患者已筛选C型肝炎，其中七例为这种感染的抗体。只有三分之一的患者已经进行过D肝炎，“与更迅速进步的”B型肝炎病毒感染的临床过程。

“这些规划，调试和管理肝病的服务，现在必须采取主机病毒的多样性考虑，”作者得出结论。 “优化管理，需要在原籍国的变量慢性HBV模式的认识。”
参考

特德RS等。慢性乙型肝炎病毒感染在英国的多样性和管理 - 敲响了警钟。临床传染病杂志，网络版，2013年。

咬牙硬挺

英国做的不咋地啊

StephenW

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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.”