Hepatitis B Virus Burden Research Articles

Abstract C59: HBV screening and vaccination among first-generation African immigrants: A pilot study

Abstract Background: African Americans disproportionately bear a large burden of hepatitis B virus (HBV)-related liver disease in the U.S. Foreign-born African immigrants have high HBV prevalence rates. However, data on the African immigrant community are sparse. Information about HBV screening, vaccination, and awareness of this vulnerable population has been less well characterized. The purpose of this study was to provide the basis for a better understanding of HBV burden in this population and identify risk factors for implementation of future preventive and treatment programs. Methods: We conducted a cross-sectional survey among 71 first-generation African Americans in New York City. Survey questions were asked regarding participants' HBV infection status, screening and vaccination history, practice of infection monitoring and treatment, knowledge of HBV transmission, and perceived barriers to screening and proper monitoring. Descriptive analyses and bivariate chi-square tests were conducted to describe the study sample and identify predictors of HBV screening and vaccination. Results: The study sample consists of 47 men and 23 women, with an average age of 33. Among the sample, 87.7% are immigrants from sub-Sahara Africa, and over 85.4% lived in the U.S. more than 15 years. About half of the participants never had HBV screening (43.6%) and never received vaccination (50%). We found a low level of HBV-related knowledge. Only about half of the participants had a correct understanding of the ways in which HBV is transmitted. Bivariate analyses showed that four factors were significantly associated with HBV screening and vaccination. Specifically, having health insurance (p < .01), a regular physician (p < .01), and college or higher degree (p < .01) are significantly associated with having HBV screening. In addition, having health insurance (p < .001) and a regular physician (p < .001) are significantly associated with having HBV screening. Furthermore, “do not have any problems/symptoms” is the most cited reason (26.75%) for not having had HBV screening. Conclusion: First-generation African immigrants in the study sample had very limited knowledge regarding HBV transmission, disease etiology, and severity, which should be the focus of future intervention to promote HBV screening and vaccination. Furthermore, we identified several predictors of HBV screening and vaccination among first-generation African immigrants. Specifically, low education, lack of health insurance, and access to a regular physician served as barriers to HBV screening and vaccination. Public health campaigns and policies need to address these social barriers. Citation Format: Grace X. Ma, Adeodat Ilboudo, Omar Dibba, Lin Zhu, Yin Tan, Olorunseun O. Ogunwobi. HBV screening and vaccination among first-generation African immigrants: A pilot study [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C59.

Economic and clinical burden of viral hepatitis in California: A population-based study with longitudinal analysis

BackgroundEconomic burden of HBV and HCV infection are trending upwards.AimsCompare hepatitis B virus (HBV) and hepatitis C virus (HCV) related hospital admission rates, charges, mortality rates, causes of death in a US population-based study.MethodsRetrospective cohort analysis of HBV and HCV patients from the California Office of Statewide Health Planning and Development (2006–2013) database.ResultsA total of 23,891 HBV and 148,229 HCV patients were identified. Across the 8-year period, the mean increase for all-cause ($1,863 vs $1,388) and liver-related hospitalization charges ($1,175 vs $675) were significantly higher for the HBV cohort compared to the HCV cohort. HBV patients had significantly higher liver-related hospital charges per person per year than HCV patients after controlling for covariates ($123,239 vs $111,837; p = 0.002). Compared to HCV patients, adjusted mortality hazard ratio was slightly lower in HBV patients (relative risk = 0.96; 95% CI 0.94–0.99). The major causes and places of death were different. The three major causes of death for HBV were: other malignant neoplasms (35%), cardiovascular disease/other circulatory disorders (17%), and liver-related disease (15%) whereas for HCV patients were: liver-related disease (22%), other malignant neoplasms (20%), and cardiovascular disease (16%). Regarding the place of death, 53% of HBV patients and 44% of HCV patients died in hospital inpatient, respectively.ConclusionsHBV patients incurred higher liver-related hospital charges and higher mean increase for all-cause and liver-related hospitalization charges over the 8-year period compared to HCV patients. HBV patients had slightly lower mortality rate and their major causes and places of death were noticeably different from HCV patients.

OP-464 - Comparison of Angiographic Burden of Coronary Artery Disease Calculated by Syntax Score in Patients with Versus Without Hepatitis B Virus Seroposivity

Background: Coronary artery disease (CAD) is the prominent cause of death for both men and women. Hepatitis B virus (HBV) infection is one of the causes of chronic liver diseases. Association between CAD and HBV enfection studied before with conflicting results. We tried to clar-ify association between HBV infection and burden of atherosclerotic disease, we used syntax score which did not used before for clarifying association between HBV infection and atherosclerotic disease .

Impact of universal infant hepatitis B vaccination in the US-affiliated Pacific Islands, 1985–2015

The US-affiliated Pacific Island countries (USAPI) is an endemic region for hepatitis B virus (HBV) infection. Universal infant hepatitis B vaccination was introduced in the USAPI in the mid-1980s to mitigate the HBV burden. We assessed the impact of universal infant vaccination on the HBV infection prevalence over time among children born in the 1980s, 1990s, and 2000s in the USAPI. Demographic and serologic data from serial sero-surveys conducted between 1985 and 2015 were obtained. Descriptive statistics and analysis of variance were performed. From data obtained from 4827 children (2–11years), HBV prevalence decreased markedly: 8.4% in the 1980s; 2.5% in the 1990s; and 0.2% in the 2000s (P<0.0001) as vaccination coverage increased: 76.4% in the 1980s; 87.3% in the 1990s; and 97.5% in the 2000s (P<0.0001). These findings underscore the protective effect of universal infant hepatitis B vaccination over time on the HBV burden in an HBV endemic region.

The Estimation of Economic Burden of Hepatitis B Virus Infection in Iran

: One of the most important public health concerns in both developing and developed countries is viral hepatitis B. It is an autoimmune liver disease, which imposes a high economic burden on individuals and the society. The aim of our study was to determine economic burden of hepatitis B virus (HBV) infection in Iran. To this end, 300 patients with HBV infection, who referred to hospitals in three cities of Iran during the year 2015, were randomly selected. To estimate the total burden of hepatitis, direct and indirect costs, costs of DALYs and social welfare were calculated which gave the costs of 7500.93 PPP$ and 96782 PPP$, respectively. Finally, our results showed that the total economic burden of HBV in Iran is dramatic which can lead to decreased quality of life of household members and damage the economy of the society. Therefore, the benefit of prevention and control measures will justify the costs from social perspective.

Profiles of Hepatitis B Virus Serological Markers among Asymptomatic Population in Anambra State, Southeastern Nigeria

Hepatitis B Virus (HBV) infection is apparent in endemic countries affecting millions of people. Further, the asymptomatic nature of the pathogen is a major public health concern. This study was designed to assess the burden of HBV by exploring the serologic markers of infection among consenting asymptomatic community dwellers in two cities in southeastern Nigeria.A total of 405 blood specimens were tested for HBsAg, anti-HBs, HBeAg, anti-HBe, total anti-HBc and anti-HBc-IgM using ELISA technique. Overall, 14 (3.5%) of the participants had detectable HBsAg out of which 1 (7.1%) had HBeAg and 13, anti-HBe. Two of the HBsAg positives (14.3%) had detectable anti-HBc-IgM. Atotal of 144 (35.5%) had detectable anti-HBc, even as 65 (57.0%) of them had the marker as the only serologic evidence of HBV exposure. Thirty-seven (9.1%) participants had anti-HBs only although all of them were born before the start of the childhood HBV vaccination. Altogether, 224 (57.3%) had no detectable serological markers of HBV infection or immunity and were obviously at risk of HBV infection.This study described various patterns of HBV serologic markers of infection in the study population and probable risk of virus spread. Our results support the need for urgent intervention and implementation of measures to control the spread of HBV infection in Nigeria.

Magnitude of Hepatitis B Virus and Hepatitis C Virus among HAART Taking Patients and Association with Liver and Renal Function and CD4+ T Cells Level

Background: Co-infection of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are very prevalent and the primary cause for morbidity and mortality among patients with Human immunodeficiency Virus (HIV). The aim of this study was to assess the magnitude of HBV and HCV infection and its association with liver and renal function, and CD4+ T cell levels of highly active anti-retroviral therapy (HAART) taking patients. Method: A hospital based cross sectional study was conducted at Zewditu Memorial Hospital. Participants’ sociodemographic and clinical information were collected from the anti-retroviral therapy (ART) database. Blood samples were collected from 384 volunteer, patients taking HAART for at least 1 year to investigate CD4, HBSAg, HCVAb, liver and renal function. Data was entered and analyzed by SPSS version 20 and p value less than 0.05 was taken as statistically significant. Results: Of the 384 participants, 222 (57.81%) were females, and 168 (43.75%) were in age group 30-39 years. Overall burden of HBV and HCV were 21 (5.7%). Co-infection rates of HBV-HIV, HCV-HIV and HBV-HCV-HIV were 18 (4.7%), 4 (1%) and 1 (0.2%), respectively. Co-infected study participants had significantly raised mean liver enzyme levels (AST, ALT and ALP) than mono-infected ones. There was no statistically significant difference for renal function parameters between mono-infected and co-infected HAART taking patients. Co-infected HIV patients had lower mean level of CD4 compared to mono-infected ones. Conclusion: HBV and HCV co-infected HIV patients are more likely to have abnormal liver enzyme levels and tend to have low mean CD4 count than mono-infected HIV patients. Large scale cohort study is recommended for consolidating the current findings.

Hepatitis B virus infection in Chinese patients with hepatitis C virus infection: prevalence, clinical characteristics, viral interactions and host genotypes: a nationwide cross-sectional study

ObjectivesLittle is known about hepatitis B virus (HBV) infection in patients with hepatitis C virus (HCV) infection in China. This study aimed to evaluate the prevalence, clinical characteristics, viral interactions...

Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: findings from the Global Burden of Disease Study 2013

Previous estimates of the burden of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) among people who inject drugs have not included estimates of the burden attributable to the consequences of past injecting. We aimed to provide these estimates as part of the Global Burden of Disease (GBD) Study 2013. We modelled the burden of HBV and HCV (including cirrhosis and liver cancer burden) and HIV at the country, regional, and global level. We extracted United Nations data on the proportion of notified HIV cases by transmission route, and estimated the contribution of injecting drug use (IDU) to HBV and HCV disease burden by use of a cohort method that recalibrated individuals' history of IDU, and accumulated risk of HBV and HCV due to IDU. We estimated data on current IDU from a meta-analysis of HBV and HCV incidence among injecting drug users and country-level data on the incidence of HBV and HCV between 1990 and 2013. We calculated estimates of burden of disease through years of life lost (YLL), years of life lived with disability (YLD), deaths, and disability-adjusted life-years (DALYs), with 95% uncertainty intervals (UIs) calculated for each metric. In 2013, an estimated 10·08 million DALYs were attributable to previous exposure to HIV, HBV, and HCV via IDU, a four-times increase since 1990. In total in 2013, IDU was estimated to cause 4·0% (2·82 million DALYs, 95% UI 2·4 million to 3·8 million) of DALYs due to HIV, 1·1% (216 000, 101 000-338 000) of DALYs due to HBV, and 39·1% (7·05 million, 5·88 million to 8·15 million) of DALYs due to HCV. IDU-attributable HIV burden was highest in low-to-middle-income countries, and IDU-attributable HCV burden was highest in high-income countries. IDU is a major contributor to the global burden of disease. Effective interventions to prevent and treat these important causes of health burden need to be scaled up. Bill & Melinda Gates Foundation and Australian National Health and Medical Research Council.

Economic burden of hepatitis B infection among patients with diabetes

ABSTRACTDespite ACIP recommendation and cost-effectiveness established in those 19–59 y old diabetes patients the uptake of Hepatitis B vaccine in diabetes patients is low. There is need to highlight the impact of Hepatitis B virus (HBV) infection in diabetes patients in terms of healthcare utilization and costs to recognize the burden of HBV in this population.This retrospective claims analysis included patients with diabetes and HBV (cases; n=1,236) and those with diabetes without HBV (controls; n=4,944), identified by ICD-9-CM diagnosis codes. Cases were matched with 4 controls using propensity score matching. Healthcare utilization and cost were compared; incremental effect of HBV infection was assessed using multivariate analysis.In the adjusted analyses, the mean number of hospitalizations (0.6 vs 0.4), outpatient service visits (34.2 vs. 20.4), and office visits (10.9 vs. 9.8) were 41%, 68%, and 11% higher, respectively, in cases vs. controls (all p<0.05). Gastroenterologist visits (0.8 vs. 0.2) and infectious disease visits (0.1 vs. 0.0) were 80% and 18% higher in subset of case and controls with these events. Cases ($39,435) incurred $16,397 incremental total costs compared with controls ($23,038). Medical ($30,968 vs. $17,765) and pharmacy costs ($8,029 vs. $5,114) were both significantly higher for cases (p < 0.0001).Healthcare utilization and costs were higher among patients with diabetes and HBV than in those with diabetes alone. These results provide evidence supporting the need for HBV vaccination among unvaccinated diabetes patients.

Abstract B37: Prevalence of viral hepatitis B and C infection among immigrants in the Baltimore-Washington metropolitan area screened from 2009-2014

Abstract Background: Chronic hepatitis B virus (HBV) infection disproportionally affects individuals born in Africa and Asia and is the leading cause of hepatocellular carcinoma worldwide. While current guidelines recommend HBV screening for persons with high risk for infection, routine testing has not been initiated. Because HBV infection is preventable by vaccination, disaggregation of HBV infection demographic data is beneficial for targeted prevention against liver cancer. Chronic hepatitis C virus (HCV) infection also leads to hepatocellular carcinoma and liver-related mortality. While no vaccination exists for HCV, education and early detection is important to reduce HCV transmission and complications. Screening recommendations suggest testing populations at high risk, especially people who have used injectable drugs and those who may have been exposed to contaminated medical procedures. Currently, epidemiology information for HCV infection in immigrants is limited. This study aims to assess the prevalence of HBV infection, HBV immunity, and HCV infection among immigrants in the Baltimore-Washington metropolitan area, screened from 2009-2014, by age, gender, and country of birth. Method: Cross-sectional data was obtained from 52 free community screening events in Washington, D.C., Maryland, and northern Virginia from November 2009 to December 2014. A total of 4439 individuals, 18 years and older participated. Each participant's blood sample was evaluated for the presence of HBV surface antigen (HBsAg) and HBV surface antibody (HBsAb). HCV antibody testing was implemented from March 2013 onward (1698 subjects). Positive results for HBV infection (HBsAg+/HBsAb-), HBV vulnerability (HBsAg-/HBsAb-, at risk for infection), and HCV infection (HCVAb+) were analyzed according to age, gender, and country of birth. Prevalence of viral hepatitis infection was calculated for African and Asian countries which were represented by at least 50 immigrant participants. Results: Among the 4136 individuals tested, the prevalence of HBV infection was 5.1%. 41.1% were unprotected and at risk for infection, and 53.8% were protected (HBsAg-/HBsAb+). There were differences in HBsAg+ prevalence depending on birth continent: 5.8% for Asia (N = 2765), 4.6% for Africa (N = 367). High prevalence (≥ 8%) of infection was evident in immigrants from Vietnam (9.0%) and China (8.8%). Intermediate prevalence (2%-7%) was evident in Ethiopia (7.8%), Nigeria (5.1%), Korea (4.4%), and Myanmar (4.1%). Gender differences between the birth continents for HBsAg+ immigrants were significant among African immigrants (8.6% for males vs. 1.6% for females, p&amp;lt;.001) and Asian immigrants (7.1% for males vs. 5.1% for females, p&amp;lt;.05). Detected HBV infection in African and Asian immigrants differed in age patterns: highest rates were found in those in the 41-50 age group (47%) for Africa, and those 51-60 (27.8%) for Asia. For countries with at least 50 participants represented, 30.4%-54.7% of immigrants from each screened country were unprotected from HBV and needed vaccination. The prevalence of HCV infection was 1.5% for the 1698 individuals screened. Differences in prevalence were seen in birth continent, with 1.5% for Asia (N = 1206) and 2.4% for Africa (N = 150). Myanmar had the highest prevalence at 4.6%. Gender differences in HCV infection by birth continent were not statistically significant. HCV+ Asian and African immigrants differed by age group: highest rates were found in those in the 71+ age group (33.3%) for Africa, and those 31-40 (33.3%) for Asia. Conclusion: This study suggests better estimates of the true burden of HBV and HCV infection among immigrants from Asia and Africa. By disaggregating screening data into age, gender, and country of birth, programs for prevention, earlier diagnosis, and linkage to care can be improved. Citation Format: Emmeline Ha, Frederic Kim, Jane Pan, Dan-Tam Phan Hong, Hee-Soon Juon. Prevalence of viral hepatitis B and C infection among immigrants in the Baltimore-Washington metropolitan area screened from 2009-2014. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B37.

Amphiregulin promotes the immunosuppressive activity of intrahepatic CD4+ regulatory T cells to impair CD8+ T-cell immunity against hepatitis B virus infection.

Hepatitis B virus (HBV) infection causes liver diseases and hepatocellular carcinoma. Immunotolerance in HBV-infected patients is one of the factors that incur failure of HBV clearance and persistent HBV amplification. However, the mechanisms underlying immunotolerance after HBV infection are yet to be thoroughly understood. Using a novel HBV mouse model, we found for the first time that epidermal growth factor receptor (EGFR) is up-regulated on intrahepatic regulatory T (Treg) cells in HBV-infected mouse livers. The EGFR-positive Treg cells are more immunosuppressive than EGFR-negative Treg cells, demonstrated by higher expression of immunosuppressive cytokines and robust inhibition of CD8+ T-cell proliferation in vitro. Furthermore, EGFR-positive Treg cells potently restrain CD8+ T-cell-mediated anti-viral activity, leading to higher HBV burden in hepatocytes. Amphiregulin, a cytokine of the EGF family, is significantly up-regulated in HBV-infected livers, but the cellular sources of amphiregulin are still elusive. Amphiregulin promotes the immunosuppressive activity of EGFR-positive Treg cells in vitro, so as to profoundly inhibit production of anti-viral components in CD8+ T cells. Taken together, our discovery elucidated a novel mechanism contributing to immunotolerance and viral amplification after HBV infection. Our study may provide new clues for developing therapeutic strategies against HBV infection.

Epidemiology of Hepatitis B and C Virus Infections and Liver Cancer in Vietnam.

Vietnam has been a highly endemic country of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections with high hepatitis B surface antigen (HBsAg) rate (8.8-19.0%) and high anti-HCV rate (1.0-3.3%) among general population. High mortality rates of liver cancer were also estimated from 14.8 to 23.7 per 100,000. Recently, the coverage of universal HB vaccination for infants has not been high as expected while there have been no other national programs against HBV and HCV infections yet. The burden of HBV and HCV-related diseases is predicted to remain a significant health problem in next decade.How to cite this articleDo SH. Epidemiology of Hepatitis B and C Virus Infections and Liver Cancer in Vietnam. Euroasian J Hepato-Gastroenterol 2015;5(1):49-51.

Chronic hepatitis B and liver cancer risks among Asian immigrants in New York City: Results from a large, community-based screening, evaluation, and treatment program.

Hepatitis B virus (HBV) infection, the predominant cause of hepatocellular carcinoma (HCC) worldwide, disproportionately affects Asian Americans. Limited data exist on the variability and characteristics of infection that determine disease progression risk within U.S. Asian ethnic subgroups. Retrospective analyses were conducted on a large, community-based HBV screening and treatment program in New York City (NYC). From 2004 to 2008, the program enrolled 7,272 Asian-born individuals. Determinants of HBV seroprevalence were calculated and risk factors for HCC progression were compared across Asian subgroups. Among newly tested individuals, 13% were HBV positive. Seroprevalence varied significantly with age, gender, education, birthplace, and family history of infection. Chinese-born individuals, particularly from the Fujian province, had the highest seroprevalence (23.2% and 33.1%, respectively). Clinical and virologic characteristics placed HBV-infected individuals at significant risk for HCC. Significant differences in HCC risk existed among Asian subgroups in bivariate analysis, including age, gender, HBV viral load, and HBeAg status. Differences in HBV genotype and family history of HCC may further HCC risk among subgroups. Asian immigrants in NYC have a high prevalence of HBV infection and are at significant risk of disease progression and HCC. Although heterogeneity in HBV seroprevalence was found by Asian subgroups, HCC risk among infected individuals was primarily explained by age and gender differences. Country and province of birth, age, and gender may further explain seroprevalence differences. Findings provide estimates of HBV burden in Asian ethnic subgroups and identify high-risk groups to target for screening and treatment that can prevent HCC.

Responding to Australia's National Hepatitis B Strategy 2010–13: gaps in knowledge and practice in relation to Indigenous Australians

The Australian National Hepatitis B Strategy 2010-13 outlines five priority areas for developing a comprehensive response to the hepatitis B virus (HBV): building partnerships and strengthening community action; preventing HBV transmission; optimising diagnosis and screening; clinical management of people with chronic hepatitis B (CHB); and developing health maintenance, care and support for people with HBV. A scoping study was used to map the main sources and types of evidence available on the epidemiology and natural history of HBV among Indigenous Australians as well as public health responses published since 2001 (January 2001-May 2013). Gaps in current knowledge were identified. While the literature documents the success of universal infant immunisation and indicates the potential for screening initiatives to identify infected and susceptible individuals, prevalence of CHB and hepatocellular cancer remain high in Indigenous Australians. Significant gaps in knowledge and practice were identified in relation to each of the five National Hepatitis B Strategy priority action areas. Successful implementation of the strategy in Indigenous communities and reducing the burden of HBV and hepatocellular cancer in Indigenous Australians will require increased investment in research and knowledge transfer across all priority areas.

Females Have a Lower Liver Histopathological Score in HBeAg-Negative Chronic Hepatitis B Than Males

Background:: More than 350 million people are chronic carriers of hepatitis B virus (HBV) and because of the high HBV-related morbidity and mortality, the global disease burden of HBV is substantial. In patients with HBeAg–negative chronic hepatitis B (CHB) with serum alanine aminotransferase (ALT) levels, 1-2 × upper limit of normal (ULN) and HBV DNA load of 10000 to 100000 copies/mL, liver biopsy should be considered and treatment may be initiated if liver biopsy shows moderate/severe necro-inflammation or significant fibrosis. A dynamic balance between viral replication and host immune response is pivotal for the pathogenesis of liver disease in HBV infection. Due to immune response variability, there is thought to be a considerable difference in the histopathologic status of liver biopsy samples present in various populations. Objectives:: Liver histopathology in asymptomatic patients with greater than 10000 DNA copies/mL despite negative Hbe Ag was studied to determine, the number of people that will benefit from a liver biopsy, and variables that will significantly be affected by viral load changes. Patients and Methods:: Eighty-two symptomless hepatitis B patients, identified during screening tests, were entered into the study. All candidates were HBS Ag Positive, Hbe Ag negative, Hbe Ab positive, HDV Ab, HIV Ab 1, 2, and HCV Ab negative. In all cases HBV DNA virus load was greater than 10000 copies/mL (2000 U/mL). Liver biopsy was done after obtaining a written consent. Liver histopathology was reported based on the histological activity index (HAI). Results:: Both HBV DNA load and serum ALT levels significantly correlated with the grade score. Both stage and grade significantly correlated with age. Stage score of liver specimens was significantly lower in women than men. Logistic regression analysis indicated that the baseline ALT and HBV DNA levels and age were independent predictors of the HAI score. Conclusions:: In 10% of the patients, liver biopsy changed the treatment plan and treatment was started despite ALT levels being less than twice the normal level.

Cardiac Involvement of Hepatitis B and C Virus Infection

Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are the cause of many different forms of heart disease worldwide and yet few cardiologists are aware of it as an etiology of heart disease, or its treatment. The burden of HBV and HCV derived heart diseases are global, with a higher prevalence in Asia, Africa, and low- and middle-income countries. The study showed that in more than 10% of Japanese patients, their cardiomyopathies are associated with HCV infection. More recently, it is found in the USA that up to 15% of patients with heart failure with myocarditis have been associated HCV infection. In contrast, in China 79% of patients with hepatocellular cancer and 37% of hepatitis C patients have heart disease, as detected by measuring a proven and sensitive biomarker of heart disease, NT-proBNP. In Pakistan, 17% of hepatitis C patients have heart diseases, as measured by this metric (NT-proBNP). Based on these data, 3% of 6.6 billion (198 million) persons worldwide are infected with HCV and 17–37% (34–73 million) persons are suffering from HCV-derived heart diseases. These figures may be comparable to the number of patients with hepatitis C. HCV infection causes only hepatitis in some patients, only heart diseases in some patients, and both hepatitis and heart diseases in other patients. A global network is required to establish methods to detect heart diseases caused by infectious agents. Other goals for the network are the expansion of preventive and therapeutic programs in under privileged countries. DOI: http://dx.doi.org/10.3329/uhj.v8i2.16084 University Heart Journal Vol. 8, No. 2, July 2012

Direct economic burden of hepatitis B virus related diseases: evidence from Shandong, China

BackgroundAlthough the expenses of liver cirrhosis are covered by a critical illness fund under the current health insurance program in China, the economic burden associated with hepatitis B virus (HBV) related diseases is not well addressed. In order to provide evidence to address the economic disease burden of HBV, we conducted a survey to investigate the direct economic burden of acute and chronic hepatitis B, cirrhosis and liver cancer caused by HBV-related disease.MethodsFrom April 2010 to November 2010, we conducted a survey of inpatients with HBV-related diseases and who were hospitalized for seven or more days in one of the seven tertiary and six secondary hospitals in Shandong, China. Patients were recorded consecutively within a three-to-five month time period from each sampled hospital; an in-person survey was conducted to collect demographic and socio-economic information, as well as direct medical and nonmedical expenses during the last month and last year prior to the current hospitalization. Direct medical costs included total outpatient, inpatient, and self-treatment expenditures; direct nonmedical costs included spending on nutritional supplements, transportation, and nursing. Direct medical costs during the current hospitalization were also obtained from the hospital financial database. The direct economic cost was calculated as the sum of direct medical and nonmedical costs. Our results call for the importance of implementing clinical guideline, improving system accountability, and helping secondary and smaller hospitals to improve efficiency. This has important policy implication for the on-going hospital reform in China.ResultsOur data based on inpatients with HBV-related diseases suggested that the direct cost in US dollars for acute hepatitis B, severe hepatitis B, chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis and primary liver cancer was $2954, $10834, $4552, $7400.28, $6936 and $10635, respectively. These costs ranged from 30.72% (for acute hepatitis B) to 297.85% (for primary liver cancer) of the average annual household income in our sample. Even for patients with health insurance, direct out-of-pocket cost of all HBV-related diseases except acute hepatitis B exceeded 40.00% of the patient’s disposable household income, making it a catastrophic expenditure for the household.ConclusionHepatitis B imposes considerable economic burden on a family. Our findings will help health policy makers’ understanding of the magnitude of the economic burden of HBV-related diseases in China. Evidence from our study also contributes to our understanding of potential benefits to society from allocating more resources to preventing and treating HBV infection, as well as increasing insurance coverage in China. These findings have important policy implications for health care reform efforts currently underway in China focusing on how to reduce the burden of catastrophic disease for its citizens.

The impact of demographic change on the estimated future burden of infectious diseases: examples from hepatitis B and seasonal influenza in the Netherlands

BackgroundFor accurate estimation of the future burden of communicable diseases, the dynamics of the population at risk – namely population growth and population ageing – need to be taken into account. Accurate burden estimates are necessary for informing policy-makers regarding the planning of vaccination and other control, intervention, and prevention measures. Our aim was to qualitatively explore the impact of population ageing on the estimated future burden of seasonal influenza and hepatitis B virus (HBV) infection in the Netherlands, in the period 2000–2030.MethodsPopulation-level disease burden was quantified using the disability-adjusted life years (DALY) measure applied to all health outcomes following acute infection. We used national notification data, pre-defined disease progression models, and a simple model of demographic dynamics to investigate the impact of population ageing on the burden of seasonal influenza and HBV. Scenario analyses were conducted to explore the potential impact of intervention-associated changes in incidence rates.ResultsIncluding population dynamics resulted in increasing burden over the study period for influenza, whereas a relatively stable future burden was predicted for HBV. For influenza, the increase in DALYs was localised within YLL for the oldest age-groups (55 and older), and for HBV the effect of longer life expectancy in the future was offset by a reduction in incidence in the age-groups most at risk of infection. For both infections, the predicted disease burden was greater than if a static demography was assumed: 1.0 (in 2000) to 2.3-fold (in 2030) higher DALYs for influenza; 1.3 (in 2000) to 1.5-fold (in 2030) higher for HBV.ConclusionsThere are clear, but diverging effects of an ageing population on the estimated disease burden of influenza and HBV in the Netherlands. Replacing static assumptions with a dynamic demographic approach appears essential for deriving realistic burden estimates for informing health policy.

Can long term therapy with oral nucleos(t)ide analogs influence the prognosis of chronic hepatitis B‐related complications?

1 the majority of whom acquire infection at birth or in early childhood. 2 It is estimated that 50% of male and 14% of female carriers will die from CHB-related com- plications such as hepatocellular carcinoma (HCC) or cirrhosis. 3 Since the global introduction of routine vaccination against hepa- titis B virus (HBV) in newborns in countries where the incidence of HBV-related complications are high, such as in theAsia-Pacific region, there has been a significant and gratifying decline in rates of CHB and HCC. 3,4 In the last decade, we have developed a better appreciation of the natural history of CHB—it appears that the progression to cirrhosis and HCC in these patients is associated with persistently high serum HBV DNA levels over time. The other major risk predictors of progression to HCC and cirrhosis include age, male gender, hepatitis B e antigen (HBeAg) status, serum alanine ami- notransferase (ALT) levels and HBV genotype. 5 Two recent land- mark clinical trials in Asia (Taiwan) clearly demonstrate the dramatic improvement in survival, reduced risk of HCC and advanced fibrosis/cirrhosis with the use of antiviral therapy. 5,6 Where treatment options are concerned, we have come a long way in the last decade—complete suppression, or elimination of HBV is now eminently feasible and well-tolerated, and should be the key management goal in the treatment of CHB. The major strides in therapy lie in the introduction of newer oral nucleos(t)ide agents with higher genetic barrier to drug resistance. 7