Hepatitis B Virus Infection Rate Research Articles

Prevalence of hepatitis B in the southeast of China

Hepatitis B is a major public health problem in China. However, in the past 10 years, estimates of the prevalence of hepatitis B virus (HBV) have been sparse, with results that do not always agree. The purpose of this study was to investigate the epidemiology of HBV in adults and to provide the most recent baseline data for planning and monitoring of health. The prevalence of HBV was determined in a community-based, cross-sectional, age-stratified sample of adults (aged 20 years or older). The study population was selected using random multistage cluster sampling. Demographic information and serological samples were obtained from 19 933 participants. The prevalence of anti-HBV core antibody, HBV surface antigen (HBsAg), and anti-HBV surface antibody was 38.6, 7.9, and 44.9%, respectively. We found statistically significant differences in hepatitis B infection between men and women (P<0.001). The prevalence of HBV infection increased with age. The rates of HBsAg positivity and HBV infection in individuals living on an island were higher than those of individuals living in plains. The alanine aminotransferase level was elevated (≥38 IU/l) in 15.7 and 7.2% of HBsAg-positive and HBsAg-negative patients; the proportion of elevated alanine aminotransferase was markedly higher in men (12.7%) than in women (4.7%) (P<0.001). The α-fetoprotein-positive rate was 2% in HBsAg-positive individuals who were aged 30 years or older. Borderline intermediate/high endemicity was found among adults in the northern region of Zhejiang Province. The vaccination program has contributed to a reduction in infection over the last 20 years, although further efforts are required to turn the region into a 'low-endemicity' area.

P1-531 Estimation of incidence rate of hepatitis B virus horizontal infection in the Japanese population in 2005

IntroductionThere have been noted that not only hepatitis B virus (HBV) vertical but horizontal infection elicits a risk of persistent HBV infection even in healthy adulthood. There is little information...

Development of chronic hepatitis B virus infection in hepatitis B surface antigen negative HIV/HBV co‐infected adults: A rare opportunistic illness

Changes in serologic status in human immunodeficiency virus (HIV)/hepatitis B virus (HBV) co-infected individuals with either isolated anti-HBc or resolved HBV infection have been reported, but the frequency of clinically meaningful long-term serologic changes is not well-defined. This study therefore, examined longitudinal serologic status for hepatitis B surface antigen (HBsAg)-negative HIV/HBV co-infected participants in a large cohort. Among 5,222 cohort participants, 347 (7%) were initially isolated anti-HBc positive, and 1,073 (21%) had resolved HBV infection (concurrently reactive for anti-HBc and anti-HBs). Thirty-three (10%) of the 347 participants with isolated anti-HBc were later positive for HBsAg at least once, compared with 3 (0.3%) of those with resolved HBV (P < 0.001). A total of 14 participants became persistently positive for HBsAg and were thus classified as having late-onset chronic HBV infection at a median of 3.7 years after initial HBV diagnosis. For those initially with HBsAg-negative HIV/HBV co-infection, the rate of late-onset chronic HBV infection was 1.39/1,000 person-years. Those with late-onset chronic HBV infection experienced significant decreases in CD4 cell counts (P = 0.002) with a mean of 132 cells/µl at the time of late-onset chronic HBV infection, but no factor distinguished those who were positive for HBsAg only once from those that developed late-onset chronic HBV infection. Over a median of 2.9 years following late-onset chronic HBV infection, 3 of 14 subsequently lost HBsAg. The occurrence of late-onset chronic HBV infection in HBsAg negative HIV/HBV co-infected adults appears to be one important, albeit rare, clinical event seen almost exclusively in those with isolated anti-HBc and low CD4 cell count.

Hepatitis B and C Infections in Hamadan Province during 2004-2009.

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are major global public health problems. This study was conducted to investigate the incidence rate of these infections over six successive years in Hamadan Province, the west of Iran. This retrospective cohort study was conducted on the database of hepatitis registry. In this study, 1257 subjects infected by HBV and 705 subjects infected by HCV were detected and enrolled. HBV infection was detected by presence of HBsAg and HCV infection by presence of Anti-HCV. In order to estimate province-based age-specific incidence rates of HBV and HCV infections, we used the same age-specific population as the denominator. The incidence rate pre 100,000 population from 2004 to 2009 for HBV infection was 19.60, 12.29, 12.31, 11.13, 9.46, 7.70 (P<0.001) and for HCV infection was 6.73, 7.42, 7.57, 8.45, 5.30, 5.17 respectively (P<0.001). The incidence rate of HBV infection decreased continuously over time, while the incidence rate of HCV infection fluctuated and even increased from 2004 to 2007 then decreased. The rate ratio of trend for HBV infection across successive years was 0.85 [95% CI: 0.82, 0.88] and that of HCV infection was 0.94 [95% CI: 0.90, 0.99]. The decreasing trend in the incidence rate of HBV infection in current years may be the result of vast national immunization of newborn and adolescents against hepatitis B infection. On the other hand, fluctuating inci-dence rate of HCV infection with a temporarily increasing growth is critical and should be the focus of the health policymakers' special attention.

Economic Analysis of Hepatitis B Screening and Treatment

Economic Analysis of Hepatitis B Screening and Treatment

HCV, HBV and Alcohol – the Dionysos Study

Population-based studies on the natural history of chronic viral liver disease that consider co-morbidity factors, such as alcohol or metabolic diseases, are lacking. We report here the contribution of ethanol intake and non-organ-specific autoantibodies (NOSA) to the course of chronic viral disease in the Dionysos cohort. As reported elsewhere, the Dionysos study was performed in two towns of Northern Italy, started in 1992 with 10 years of follow-up in 2002, and allowed us to quantify the burden of chronic liver disease in Northern Italy. We followed 139 subjects with chronic hepatitis C virus (HCV) infection and 61 with chronic hepatitis B virus (HBV) infection for a median (IQR) time of 8.4 (1.0) and 8.3 (0.9) years, respectively. The incidence and remission rates of steatosis were 9.0 and 29.7 per 1,000 person-years in the HCV cohort and 4.0 and 30.4 per 1,000 person-years in the HBV cohort. Progression to cirrhosis and hepatocarcinoma was more common in the HCV than in the HBV cohort. In the HCV cohort, ethanol intake was an independent predictor of liver cirrhosis and of death rate in both cohorts. We found no association between baseline NOSA and 8.4-year mortality. We conclude that morbidity and mortality rate of HBV and HCV infection in the general population is lower than that reported in secondary care populations, blood donors, or clinical series, and that ethanol intake >30 g/day is the most important and evitable risk factor for cirrhosis and death in patients with chronic HCV or HBV infection.

Hepatitis B virus in Pakistan: A systematic review of prevalence, risk factors, awareness status and genotypes

In Pakistan, there are estimated 7-9 million carriers of hepatitis B virus (HBV) with a carrier rate of 3-5%. This article reviews the available literature about the prevalence, risk factors, awareness status and genotypes of the HBV in Pakistan by using key words; HBV prevalence, risk factors, awareness status and genotypes in Pakistani population in PubMed, PakMediNet, Directory of Open Access Journals (DOAJ) and Google Scholar. One hundred and six different studies published from 1998 to 2010 were included in this study. Weighted mean and standard deviation were determined for each population group. The percentage of hepatitis B virus infection in general population was 4.3318% ± 1.644%, healthy blood donors (3.93% ± 1.58%), military recruits (4.276% ± 1.646%), healthcare persons (3.25% ± 1.202%), pregnant women (5.872% ± 4.984), prisoners (5.75% ± 0.212%), surgical patients (7.397% ± 2.012%), patients with cirrhosis (28.87% ± 11.90%), patients with HCC (22% ± 2.645%), patients with hepatitis (15.896% ± 14.824%), patients with liver diseases (27.54% ± 6.385%), multiple transfused patients (6.223% ± 2.121%), opthalmic patients (3.89% ± 1.004%) and users of injectable drugs (14.95% ± 10.536%). Genotype D (63.71%) is the most prevalent genotype in Pakistani population. Mass vaccination and awareness programs should be initiated on urgent basis especially in populations with HBV infection rates of more than 5%.

HBV and lymphoma: HIV matters

A recent article by Engels et al.[1] published in the Lancet Oncology concludes that persons with hepatitis B virus (HBV) are at greater risk of developing non-Hodgkin lymphoma (NHL) compared to HBV-negative individuals. However, they have failed to account for their cohort's HIV status [1]. Patients with HIV/AIDS are up to 100 times more likely to develop NHL probably because of oncogenic viruses and excessive stimulation of B cells by HIV [2]. Despite a decrease of NHL incidence in the post-HAART era as antiretrovirals suppress B-cell stimulation, NHL remains the second commonest tumour associated with HIV-1 [3,4]. Furthermore, as many as 10% of HIV-positive patients are co-infected with HBV, in most cases due to overlapping routes of transmission [5]. To investigate the relationship between HIV, HBV and NHL further, we analysed data from 464 patients with an HIV-positive status who developed lymphoma. Of these, 5.3% of patients with Burkitt lymphoma, 7.1% of patients with diffuse large B-cell lymphoma, and 11.7% of patients with Hodgkin disease were HBV surface antigen positive ever during follow-up. Although a higher incidence of HBV in NHL patients could suggest that HBV plays a role in lymphomagenesis, it is impossible to generate this conclusion when HIV could be a confounding variable. Therefore, we analysed 555 individuals co-infected with HBV and HIV who were followed for a total of 3098 patient-years (calculated from the time they were HBV surface antigen positive to the last clinic date or date they developed NHL, whichever was sooner). Twelve patients presented with NHL at baseline and were thus excluded from our analysis, although HBV could have contributed. Eight patients (1.4%, incidence: 25.8/10 000 patient-years) developed NHL during follow-up and four patients developed Hodgkin lymphoma (0.72%, unadjusted incidence ratio 12.9/10 000 patient-years). Of these eight patients with NHL, four were diagnosed with large B-cell lymphoma and two with Burkitt lymphoma. Our patients were more than 10 times more likely to develop NHL than those in the Korean cohort. In a previous study, we followed 5832 HIV-positive patients for 34 133 person-years, during which 102 developed NHL (1.7%, incidence: 29.9/10 000 person-years) regardless of HBV status [6]. Combined, these data strongly suggest that HBV positivity does not put patients with HIV at a greater risk for NHL (unadjusted rate ratio: 0.86, 95% CI 0.64–1.09). Our results agree with a previously published Swiss study that also found that HBV and HIV co-infection did not increase a patient's risk of NHL compared to HIV infection alone [7]. Because HIV is associated with higher rates of HBV infection and HIV-positive increases incidence rate of NHL, this accounts for our over all higher incidence rates of NHL compared to the South Korean study. Engels et al. cannot conclude that HBV-positive persons are at higher risk for NHL without first eliminating the possibility that the increased risk is due to a sub-population of HBV-positive patients co-infected with HIV (a point that most reviewers of the paper made).

Liver function tests as indicators of metabolic syndrome

Liver function tests as indicators of metabolic syndrome

Prevalence of hepatitis B genotype and viral basic core promoter and precore mutations among teenagers in Macao: relationship with hepatocellular carcinoma development

Chronic hepatitis B virus (HBV) infection is a global problem and over 75% of cases are reported in the Asia Pacific region. Infection can lead to progressive liver disease, cirrhosis and hepatocellular carcinoma (HCC). Previous studies suggest the prevalence of HBV carriers in Macau to be approximately 10% of the population. This study aims to investigate the prevalence of HBV genotypes among HBV-positive teenagers in Macao and the prevalence of base core promoter (BCP) and precore (PreC) mutations in the viral genome. In addition, through monitoring aminotransferase and α-fetoprotein, it aims to investigate relationships among HBV genotypes, BCP/PreC mutations and HCC development. This study recruited 1991 teenagers in Macau in 2008, and the PreS1/S2, BCP and PreC region of the HBV genome from 34 HBsAg-positive subjects were amplified and sequenced to determine HBV genotype and presence of HCC-associated mutations. Results suggested that the average rate of HBV infection among secondary school teenagers in Macao is low, and HBV genotype B and C viruses were found to predominate in Macao. The BCP/PreC mutations A1762T, G1764A, G1896A and C1766T were identified in 2.9–11.7% of subjects. However, no significant relationship was observed between HBV genotype, BCP/PreC mutations and HCC development.

Seroprevalence and Risk Factors for Hepatitis B Infection in an Adult Population in Northeast China

The prevalence of the hepatitis B virus (HBV) is higher in adults than in children. We determined the seroepidemiology of HBV infection in an adult population in JiLin, China, to guide effective preventive measures. A cross-sectional serosurvey was conducted throughout JiLin, China. A total of 3833 people was selected and demographic and behavioral information gathered. Serum samples were tested for HBV markers and liver enzymes. The prevalence of the hepatitis B surface antigen (HBsAg), the antibody to the hepatitis B surface antigen (anti-HBs), the hepatitis B e antigen (HBeAg), the antibody to HBeAg (anti-HBe), and the antibody to the hepatitis B core antigen (anti-HBc) were 4.38%, 35.66%, 1.38%, 6.65%, and 40.88%, respectively. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were significantly higher among HBsAg (+) than HBsAg (-) subjects. By multivariate logistic regression analysis, independent predictors for chronic HBV infection were smoking, poor sleep quality; occupation as private small-businessmen, laborers, or peasants; male gender; family history of HBV; personal history of vaccination; and older age. Independent predictors for exposure to HBV were large family size, occupation as a private small-businessman, male gender, family history of HBV, personal history of vaccination, and older age. Independent predictors for immunity by vaccination were occupation as a private small-businessman, high income, personal history of vaccination, and young age. Independent predictors for immunity by exposure were drinking, male gender, personal history of vaccination, and older age. The prevalence rate of HBV infection (4.38%) was lower than the previous rate of general HBV vaccination. However, 44.59% of the population remained susceptible to HBV. The prevalence of HBV infection was high in young adults, private small-businessmen, peasants, those with a family history of HBV, and males. Therefore, immunization of the non-immune population is reasonable to reduce hepatitis B transmission between adults.

Detection of hepatitis B virus DNA among accepted blood donors in Nanjing, China

BackgroundPosttransfusion hepatitis B virus (HBV) infection still occurs although its incidence has been substantially reduced since the introduction of screening of hepatitis B surface antigen (HBsAg) in blood donors. This study aimed to investigate the occult HBV infection in accepted blood donors in Nanjing, China.ResultsThe lower detection limit of the nested PCR in this study was estimated to be 20 copies/ml HBV DNA. The positive rate of occult HBV infection was 0.13% (5 of 2972) in the accepted blood donors. Sequencing data showed that the amplified HBV sequences were not identical each other and to the known sequences cloned in our laboratory, excluding the false-positive caused by cross-contamination. Phylogenetic analysis showed that the HBV in all five donors was genotype B; a single base deletion was detected in the S region of HBV DNA from one donor, and no mutation was observed in the "a" determinant of HBsAg from four other donors. All five donors were negative for anti-HBs and one was positive for anti-HBc.ConclusionsThe prevalence of occult HBV infection in the accepted blood donors in Nanjing, China is relatively high. The data would be meaningful in adapting strategy to eliminate posttransfusion HBV infection in China.

Hepatitis B ESL Education for Asian Immigrants

Asian communities in North America include large numbers of immigrants with limited English proficiency. Hepatitis B virus (HBV) infection is endemic in most Asian countries and, therefore, Asian immigrant groups have high rates of chronic HBV infection. We conducted a group-randomized trial to evaluate the effectiveness of a hepatitis B English as a second language (ESL) educational curriculum for Asian immigrants. Eighty ESL classes were randomized to experimental (hepatitis B education) or control (physical activity education) status. Students who reported they had not received a HBV test (at baseline) completed a follow-up survey 6 months after randomization. The follow-up survey assessed recent HBV testing and HBV-related knowledge. Provider reports were used to verify self-reported HBV tests. The study group included 218 students who reported they had not been tested for HBV. Follow-up surveys were completed by 180 (83%) of these students. Provider records verified HBV testing for 6% of the experimental group students and 0% of the control group students (P = 0.02). Experimental group students were significantly (P < 0.05) more likely than control group students to know that immigrants have high HBV infection rates, HBV can be spread during sexual intercourse and by sharing razors, and HBV infection can cause liver cancer. Our ESL curriculum had a meaningful impact on HBV-related knowledge and a limited impact on HBV testing levels. Future research should evaluate the effectiveness of ESL curricula for other immigrant groups and other health topics, as well as other intervention approaches to increasing levels of HBV testing in Asian immigrant communities.

Dynamical behavior of a hepatitis B virus transmission model with vaccination

Hepatitis B virus (HBV) infection is a globally health problem. In 2005, the WHO Western Pacific Regional Office set a goal of reducing chronic HBV infection rate to less than 2% among children five years of age by 2012, as an interim milestone towards the final goal of less than 1%. Many countries made some plans (such as free HBV vaccination program for all neonates in China now) to control the transmission HBV. We develop a model to explore the impact of vaccination and other controlling measures of HBV infection. The model has simple dynamical behavior which has a globally asymptotically stable disease-free equilibrium when the basic reproduction number R 0 ≤ 1 , and a globally asymptotically stable endemic equilibrium when R 0 > 1 . Numerical simulation results show that the vaccination is a very effective measure to control the infection and they also give some useful comments on controlling the transmission of HBV.

Review article: Hepatitis B and dialysis

The incidence of hepatitis B virus (HBV) infection in dialysis populations has declined over recent decades, largely because of improvements in infection control and widespread implementation of HBV vaccination. Regardless, outbreaks of infection continue to occur in dialysis units, and prevalence rates remain unacceptably high. For a variety of reasons, dialysis patients are at increased risk of acquiring HBV. They also demonstrate different disease manifestations compared with healthy individuals and are more likely to progress to chronic carriage. This paper will review the epidemiology, modes of transmission and diagnosis of HBV in this population. Prevention and treatment will be discussed, with a specific focus on strategies to improve vaccination response, new therapeutic options and selection of patients for therapy.

Hepatitis B vaccination and risk of hepatitis B infection in HIV-infected individuals.

To assess the association of hepatitis B virus (HBV) vaccination with risk of HBV infection among HIV-infected patients and HBV infection risk factors among vaccinees. Observational cohort study. Participants enrolled from 1986 through 2004, unvaccinated and serologically negative for HBV infection at the time of HIV diagnosis, were followed longitudinally through 2007 for the occurrence of HBV infection. Risk factors for HBV infection were evaluated using time to event methods, including Kaplan-Meier survival curves and Cox proportional hazards models. During 11 632 person-years of follow-up, the rate of HBV infection was 2.01 (95% CI 1.75-2.27)/100 person-years. Receipt of at least one dose of vaccine was not associated with reduced risk of HBV (unadjusted hazard ratio 0.86, 95% CI 0.7-1.1; adjusted hazard ratio 1.08, 95% CI 0.8-1.4). Receipt of three or more doses of vaccine was also not associated with reduced risk (hazard ratio 0.96; 95% CI 0.56-1.64). Among 409 vaccinees with HBsAb less than 10 IU/l, 46 (11.2%) developed HBV infection compared with 11 of 217 (5.1%) vaccinees with HBsAb > or =10 IU/l (hazard ratio 0.51; 95% CI 0.3-1.0). In participants with initial HBsAb less than 10 IU/l, 16 of 46 (35%) infections were chronic, compared with none of 11 in those with initial HBsAb at least 10 IU/l (P = 0.02). Overall, HBV vaccination was not associated with reduced risk of HBV infection in our cohort of HIV-infected individuals. However, the small subset of vaccinees with a positive vaccine response may have had reduced HBV infection risk, including chronic disease. Improvements in vaccine delivery and immunogenicity are needed to increase HBV vaccine effectiveness in HIV-infected patients.

Health disparities or data disparities: sampling issues in hepatitis B Virus infection among Asian American Pacific Islander studies

Hepatitis B virus (HBV) infection in Asian American Pacific Islanders (AAPIs) is an important health problem that must be recognized and addressed by the U.S. public health policy. However, AAPIs have been to a large degree invisible in public health data and debates and their interests have been disregarded. Moreover, an estimation of HBV infection rates reported from the National Nutritional and Health Survey Examinations III was 1.25 million; however, an estimate based on AAPI-targeted studies places the number at almost 2 million. This article discusses the perils of application of textbook methods of sampling coverage, selection, and nonresponse in studies related to AAPIs and the importance to note that some rapidly increasing racial/ethnic groups such as AAPIs have linguistic and cultural differences and these differences often cause such groups to be omitted from data collection.

Current therapeutic strategies for recurrent hepatitis B virus infection after liver transplantation

Hepatitis B virus (HBV)-related liver disease is the leading indication for liver transplantation (LT) in Asia, especially in China. With the introduction of hepatitis B immunoglobulin (HBIG) and oral antiviral drugs, the recurrent HBV infection rate after LT has been evidently reduced. However, complete eradication of recurrent HBV infection after LT is almost impossible. Recurrent graft infection may lead to rapid disease progression and is a frequent cause of death within the first year after LT. At present, the availability of new oral medications, especially nucleoside or nucleotide analogues such as adefovir dipivoxil, entecavir and tenofovir disoproxil fumarate, further strengthens our ability to treat recurrent HBV infection after LT. Moreover, since combined treatment with HBIG and antiviral agents after liver re-transplantation may play an important role in improving the prognosis of recurrent HBV infection, irreversible graft dysfunction secondary to recurrent HBV infection in spite of oral medications should no longer be considered an absolute contraindication for liver re-transplantation. Published reviews focusing on the therapeutic strategies for recurrent HBV infection after LT are very limited. In this article, the current therapeutic strategies for recurrent HBV infection after LT and evolving new trends are reviewed to guide clinical doctors to choose an optimal treatment plan in different clinical settings.

Epidemiology and prevention of hepatitis B virus in China

Hepatitis B virus (HBV) infection is prevalent in China. Approximately 600 million people have ever been infected by HBV. About 130 million are HBV chronic carriers and 30 million HB patients. Among them, 50% of HBV carriers are caused by carrier mothers to born infants. Around 300 000 people died of liver disease including liver cirrhosis and primary hepatocellular carcinoma each year and 50% of them died of primary hepatocellular carcinoma. HBV infection is not only the health problem but also becoming a social problem. HBV chronic carriers and patients have endured the great pressure from disease burden and social discrimination. According to the report of the national screening program of HBV released by the ministry of health in 2008, China has taken many effective measures to control the HBV infection, including vaccine immunization program, strengthening the management of blood sources and blood productions, prevention of nosocomial HBV infection, strengthening health education on HBV infection and safe injection techniques. The implementation of HB vaccine immunization program, which China officially introduced into the national immunization program since 1992, has dramatically reduced the incidence of HBV infection among infants and children. Integrated with other interventions, the rate of HBV infection decreased gradually. According to the survey of the national screening program of HBV in 2006, compared with the incidence of HBV in 1992, the incidence rate of HBsAg positive has decreased 26.36%, the number of children who have ever been infected by HBV decreased 80 million since 1992. However some problems are still existing. The solutions of low rate of vaccination in rural areas and migration population, lacking of practical measures on management of hepatitis B patients, the occurrence of health care acquired HBV infection, and low rate of vaccination among high risk groups have also been recommended.

Low prevalence of hepatitis B virus infection in patients with systemic lupus erythematosus in southern China

To investigate the prevalence of hepatitis B virus (HBV) infection in systemic lupus erythematosus (SLE) patients in southern China, SLE inpatients were retrospectively investigated for their HBV infection rate. Fifteen SLE patients positive for hepatitis B surface antigen (HBsAg) were followed up. Furthermore, serum interferon (IFN)-α levels among SLE patients were detected by ELISA. Results showed estimated HBsAg-positive rate was 10.74% in general population. The HBsAg-positive rate was lower in SLE patients compared with controls (2.33 vs. 9.57%, P < 0.01). Interestingly, 13 out of 15 SLE patients converted from HBsAg positive to HBV surface antibody (HBsAb) positive even under glucocorticoid therapy. In addition, we found significantly increased IFN-α levels in SLE patients.The prevalence of HBV infection in SLE patients was lower than that in sex- and age-matched non-SLE controls in southern China. The characteristic IFN signatures in SLE may favor the subsequent clearance of HBV.