The diversity and management of chronic hepatitis B virus infections in the United Kingdom: A wake-up call

Richard Tedder; Alison J. Rodger; Lori Fries; Samreen Ijaz; Mark Thursz; William Rosenberg; Nikolai Naoumov; Jangu Banatvala; Roger Williams; Geoffrey Dusheiko; Shilpa Chokshi; Terry Wong; Gillian Rosenberg; Sulleman Moreea; Margaret Bassendine; Michael Jacobs; Peter R. Mills; David Mutimer; Stephen D. Ryder; Andrew Bathgate; Hyder Hussaini; John F. Dillon; Mark Wright; George Bird; Jane Collier; Michael Anderson; Anne M. Johnson

doi:10.1093/cid/cis1013

The diversity and management of chronic hepatitis B virus infections in the United Kingdom: A wake-up call

Richard Tedder, Alison J. Rodger^*, Lori Fries, Samreen Ijaz, Mark Thursz, William Rosenberg, Nikolai Naoumov, Jangu Banatvala, Roger Williams, Geoffrey Dusheiko, Shilpa Chokshi, Terry Wong, Gillian Rosenberg, Sulleman Moreea, Margaret Bassendine, Michael Jacobs, Peter R. Mills, David Mutimer, Stephen D. Ryder, Andrew BathgateHyder Hussaini, John F. Dillon, Mark Wright, George Bird, Jane Collier, Michael Anderson, Anne M. Johnson

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

34 Citations (Scopus)

Abstract

Background. Through migration, diversity of chronic hepatitis B virus (HBV) infection has changed, affecting disease burden and control. We describe clinical and viral characteristics of chronic HBV in the United Kingdom. Methods. A total of 698 individuals with chronic HBV infection were recruited from referral liver centers. Demographic, clinical, and laboratory data were collected. Results. Sixty-one percent of patients were male, 80% were not born in the United Kingdom, and the largest ethnicity was East/Southeast Asian (36%). Twenty-two percent were hepatitis B e antigen (HBeAg) seropositive; 20.4% (59/289) had cirrhosis and 10 (1.7%) had hepatocellular carcinoma. Genotype D was most common (31%) followed by A, C, B, and E (20%, 20%, 19%, and 9%, respectively). Genotype was significantly associated with country of birth, length of time in the United Kingdom, HBeAg status, and precore and basal core promoter mutations. One-third were on treatment, with men independently more likely to be treated. Only 18% of those on treatment were on recommended first-line therapies, and 30% were on lamivudine monotherapy. Among treated individuals, 27% had antiviral drug resistance. Testing rates for human immunodeficiency virus, hepatitis C virus, and delta coinfections were low. Conclusions. We 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-thanoptimal clinical management practices, possible gender-based treatment bias, and the need to improve testing for coinfections.

Original language	English
Pages (from-to)	951-960
Number of pages	10
Journal	Clinical Infectious Diseases
Volume	56
Issue number	7
DOIs	https://doi.org/10.1093/cid/cis1013
Publication status	Published - 1 Apr 2013

Bibliographical note

Funding Information:
Potential conflicts of interest. The study was part funded by industry through the unrestricted grants listed above. R. S. T. has received an honorarium from Gilead Sciences. A. M. J., A. J. R., and L. F. received funding from unrestricted grants as listed above, and A. M. J. is also a governor of the Wellcome Trust. A. J. R. also received nonrestricted grant funding from Gilead. T. W. has served on advisory boards and/or received honoraria from Novartis, Bristol-Myers Squibb (BMS), and Gilead. M. J. has received travel grants and consulted for Gilead. N. N. is an employee of Novartis (Basel, Switzerland). S. M. has served on advisory boards and/or received honoraria from AstraZeneca, BMS, Gilead, Janssen-Cilag, Merck Sharp & Dohme (MSD), and Roche. G. D. has received consulting fees from Abbott, Boehringer Ingelheim, BMS, GlaxoSmithKline, Human Genome Sciences, Novartis, Pharmasset, Pfizer, Roche–Genentech, Scher-ing-Plough (Merck), Tibotec, Vertex Pharmaceuticals, Janssen, ZymoGe-netics, and Gilead Sciences. His institution has received grant support from Gilead Sciences, Janssen, Novartis, Pharmasset, Hoffmann–La Roche, Schering-Plough (Merck), Tibotec, and Vertex. W. R. sits on advisory boards for Roche and Gilead and has received research support from Roche. M. B. has received travel grants and/or honoraria for presentations/ advisory boards from MSD, Gilead Sciences, Janssen, and BMS and has received fellowships from Gilead Sciences. M. T. has received consulting and lecture fees from Gilead, BMS, Abbott, and MSD. All other authors report no potential conflicts.

Funding Information:
Financial support. The work was supported through unrestricted educational grants from The Nuffield Trust, BMS, Novartis, Gilead, and Roche. The industry funders had no role in any aspect of the study other than receiving study progress updates.

Keywords

Clinical outcomes
Cross-sectional
Genotypes
Hepatitis B virus
Virology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/cid/cis1013

Cite this

Tedder, R., Rodger, A. J., 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, P. R., Mutimer, D., Ryder, S. D., ... Johnson, A. M. (2013). The diversity and management of chronic hepatitis B virus infections in the United Kingdom: A wake-up call. Clinical Infectious Diseases, 56(7), 951-960. https://doi.org/10.1093/cid/cis1013

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title = "The diversity and management of chronic hepatitis B virus infections in the United Kingdom: A wake-up call",

abstract = "Background. Through migration, diversity of chronic hepatitis B virus (HBV) infection has changed, affecting disease burden and control. We describe clinical and viral characteristics of chronic HBV in the United Kingdom. Methods. A total of 698 individuals with chronic HBV infection were recruited from referral liver centers. Demographic, clinical, and laboratory data were collected. Results. Sixty-one percent of patients were male, 80% were not born in the United Kingdom, and the largest ethnicity was East/Southeast Asian (36%). Twenty-two percent were hepatitis B e antigen (HBeAg) seropositive; 20.4% (59/289) had cirrhosis and 10 (1.7%) had hepatocellular carcinoma. Genotype D was most common (31%) followed by A, C, B, and E (20%, 20%, 19%, and 9%, respectively). Genotype was significantly associated with country of birth, length of time in the United Kingdom, HBeAg status, and precore and basal core promoter mutations. One-third were on treatment, with men independently more likely to be treated. Only 18% of those on treatment were on recommended first-line therapies, and 30% were on lamivudine monotherapy. Among treated individuals, 27% had antiviral drug resistance. Testing rates for human immunodeficiency virus, hepatitis C virus, and delta coinfections were low. Conclusions. We 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-thanoptimal clinical management practices, possible gender-based treatment bias, and the need to improve testing for coinfections.",

keywords = "Clinical outcomes, Cross-sectional, Genotypes, Hepatitis B virus, Virology",

author = "Richard Tedder and Rodger, {Alison J.} and Lori Fries and Samreen Ijaz and Mark Thursz and William Rosenberg and Nikolai Naoumov and Jangu Banatvala and Roger Williams and Geoffrey Dusheiko and Shilpa Chokshi and Terry Wong and Gillian Rosenberg and Sulleman Moreea and Margaret Bassendine and Michael Jacobs and Mills, {Peter R.} and David Mutimer and Ryder, {Stephen D.} and Andrew Bathgate and Hyder Hussaini and Dillon, {John F.} and Mark Wright and George Bird and Jane Collier and Michael Anderson and Johnson, {Anne M.}",

note = "Funding Information: Potential conflicts of interest. The study was part funded by industry through the unrestricted grants listed above. R. S. T. has received an honorarium from Gilead Sciences. A. M. J., A. J. R., and L. F. received funding from unrestricted grants as listed above, and A. M. J. is also a governor of the Wellcome Trust. A. J. R. also received nonrestricted grant funding from Gilead. T. W. has served on advisory boards and/or received honoraria from Novartis, Bristol-Myers Squibb (BMS), and Gilead. M. J. has received travel grants and consulted for Gilead. N. N. is an employee of Novartis (Basel, Switzerland). S. M. has served on advisory boards and/or received honoraria from AstraZeneca, BMS, Gilead, Janssen-Cilag, Merck Sharp & Dohme (MSD), and Roche. G. D. has received consulting fees from Abbott, Boehringer Ingelheim, BMS, GlaxoSmithKline, Human Genome Sciences, Novartis, Pharmasset, Pfizer, Roche–Genentech, Scher-ing-Plough (Merck), Tibotec, Vertex Pharmaceuticals, Janssen, ZymoGe-netics, and Gilead Sciences. His institution has received grant support from Gilead Sciences, Janssen, Novartis, Pharmasset, Hoffmann–La Roche, Schering-Plough (Merck), Tibotec, and Vertex. W. R. sits on advisory boards for Roche and Gilead and has received research support from Roche. M. B. has received travel grants and/or honoraria for presentations/ advisory boards from MSD, Gilead Sciences, Janssen, and BMS and has received fellowships from Gilead Sciences. M. T. has received consulting and lecture fees from Gilead, BMS, Abbott, and MSD. All other authors report no potential conflicts. Funding Information: Financial support. The work was supported through unrestricted educational grants from The Nuffield Trust, BMS, Novartis, Gilead, and Roche. The industry funders had no role in any aspect of the study other than receiving study progress updates.",

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month = apr,

day = "1",

doi = "10.1093/cid/cis1013",

language = "English",

volume = "56",

pages = "951--960",

journal = "Clinical Infectious Diseases",

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Tedder, R, 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, SD, Bathgate, A, Hussaini, H, Dillon, JF, Wright, M, Bird, G, Collier, J, Anderson, M & Johnson, AM 2013, 'The diversity and management of chronic hepatitis B virus infections in the United Kingdom: A wake-up call', Clinical Infectious Diseases, vol. 56, no. 7, pp. 951-960. https://doi.org/10.1093/cid/cis1013

TY - JOUR

T1 - The diversity and management of chronic hepatitis B virus infections in the United Kingdom

T2 - A wake-up call

AU - Tedder, Richard

AU - Rodger, Alison J.

AU - Fries, Lori

AU - Ijaz, Samreen

AU - Thursz, Mark

AU - Rosenberg, William

AU - Naoumov, Nikolai

AU - Banatvala, Jangu

AU - Williams, Roger

AU - Dusheiko, Geoffrey

AU - Chokshi, Shilpa

AU - Wong, Terry

AU - Rosenberg, Gillian

AU - Moreea, Sulleman

AU - Bassendine, Margaret

AU - Jacobs, Michael

AU - Mills, Peter R.

AU - Mutimer, David

AU - Ryder, Stephen D.

AU - Bathgate, Andrew

AU - Hussaini, Hyder

AU - Dillon, John F.

AU - Wright, Mark

AU - Bird, George

AU - Collier, Jane

AU - Anderson, Michael

AU - Johnson, Anne M.

N1 - Funding Information: Potential conflicts of interest. The study was part funded by industry through the unrestricted grants listed above. R. S. T. has received an honorarium from Gilead Sciences. A. M. J., A. J. R., and L. F. received funding from unrestricted grants as listed above, and A. M. J. is also a governor of the Wellcome Trust. A. J. R. also received nonrestricted grant funding from Gilead. T. W. has served on advisory boards and/or received honoraria from Novartis, Bristol-Myers Squibb (BMS), and Gilead. M. J. has received travel grants and consulted for Gilead. N. N. is an employee of Novartis (Basel, Switzerland). S. M. has served on advisory boards and/or received honoraria from AstraZeneca, BMS, Gilead, Janssen-Cilag, Merck Sharp & Dohme (MSD), and Roche. G. D. has received consulting fees from Abbott, Boehringer Ingelheim, BMS, GlaxoSmithKline, Human Genome Sciences, Novartis, Pharmasset, Pfizer, Roche–Genentech, Scher-ing-Plough (Merck), Tibotec, Vertex Pharmaceuticals, Janssen, ZymoGe-netics, and Gilead Sciences. His institution has received grant support from Gilead Sciences, Janssen, Novartis, Pharmasset, Hoffmann–La Roche, Schering-Plough (Merck), Tibotec, and Vertex. W. R. sits on advisory boards for Roche and Gilead and has received research support from Roche. M. B. has received travel grants and/or honoraria for presentations/ advisory boards from MSD, Gilead Sciences, Janssen, and BMS and has received fellowships from Gilead Sciences. M. T. has received consulting and lecture fees from Gilead, BMS, Abbott, and MSD. All other authors report no potential conflicts. Funding Information: Financial support. The work was supported through unrestricted educational grants from The Nuffield Trust, BMS, Novartis, Gilead, and Roche. The industry funders had no role in any aspect of the study other than receiving study progress updates.

PY - 2013/4/1

Y1 - 2013/4/1

N2 - Background. Through migration, diversity of chronic hepatitis B virus (HBV) infection has changed, affecting disease burden and control. We describe clinical and viral characteristics of chronic HBV in the United Kingdom. Methods. A total of 698 individuals with chronic HBV infection were recruited from referral liver centers. Demographic, clinical, and laboratory data were collected. Results. Sixty-one percent of patients were male, 80% were not born in the United Kingdom, and the largest ethnicity was East/Southeast Asian (36%). Twenty-two percent were hepatitis B e antigen (HBeAg) seropositive; 20.4% (59/289) had cirrhosis and 10 (1.7%) had hepatocellular carcinoma. Genotype D was most common (31%) followed by A, C, B, and E (20%, 20%, 19%, and 9%, respectively). Genotype was significantly associated with country of birth, length of time in the United Kingdom, HBeAg status, and precore and basal core promoter mutations. One-third were on treatment, with men independently more likely to be treated. Only 18% of those on treatment were on recommended first-line therapies, and 30% were on lamivudine monotherapy. Among treated individuals, 27% had antiviral drug resistance. Testing rates for human immunodeficiency virus, hepatitis C virus, and delta coinfections were low. Conclusions. We 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-thanoptimal clinical management practices, possible gender-based treatment bias, and the need to improve testing for coinfections.

AB - Background. Through migration, diversity of chronic hepatitis B virus (HBV) infection has changed, affecting disease burden and control. We describe clinical and viral characteristics of chronic HBV in the United Kingdom. Methods. A total of 698 individuals with chronic HBV infection were recruited from referral liver centers. Demographic, clinical, and laboratory data were collected. Results. Sixty-one percent of patients were male, 80% were not born in the United Kingdom, and the largest ethnicity was East/Southeast Asian (36%). Twenty-two percent were hepatitis B e antigen (HBeAg) seropositive; 20.4% (59/289) had cirrhosis and 10 (1.7%) had hepatocellular carcinoma. Genotype D was most common (31%) followed by A, C, B, and E (20%, 20%, 19%, and 9%, respectively). Genotype was significantly associated with country of birth, length of time in the United Kingdom, HBeAg status, and precore and basal core promoter mutations. One-third were on treatment, with men independently more likely to be treated. Only 18% of those on treatment were on recommended first-line therapies, and 30% were on lamivudine monotherapy. Among treated individuals, 27% had antiviral drug resistance. Testing rates for human immunodeficiency virus, hepatitis C virus, and delta coinfections were low. Conclusions. We 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-thanoptimal clinical management practices, possible gender-based treatment bias, and the need to improve testing for coinfections.

KW - Clinical outcomes

KW - Cross-sectional

KW - Genotypes

KW - Hepatitis B virus

KW - Virology

UR - http://www.scopus.com/inward/record.url?scp=84875041717&partnerID=8YFLogxK

U2 - 10.1093/cid/cis1013

DO - 10.1093/cid/cis1013

M3 - Review article

C2 - 23223601

AN - SCOPUS:84875041717

SN - 1058-4838

VL - 56

SP - 951

EP - 960

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 7

ER -

The diversity and management of chronic hepatitis B virus infections in the United Kingdom: A wake-up call

Abstract

Bibliographical note

Keywords

UN SDGs

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