Summary Are newly diagnosed patients with HBV and HCV infection different ? Comparison between 2...
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Transcript of Summary Are newly diagnosed patients with HBV and HCV infection different ? Comparison between 2...
Summary
Are newly diagnosed patients with HBV and HCV infection different ?
Comparison between 2 prospective registries of the Belgian Association for the Study of the Liver
Bénédicte De Vroey1, Christophe Moreno2, Wim Laleman3, Marc van Gossum4, Isabelle Colle5, Chantal de Galocsy6, Philippe Langlet7, Geert Robaeys8, Hans Orlent9, Peter Michielsen10, Jean Delwaide11, Hendrik Reynaert12, Michael Adler2, Jean Henrion1, Pierre Deltenre1
1 Hôpital de Jolimont, Haine-Saint-Paul, Belgium, 2 Hôpital Erasme, Brussels, Belgium, 3 KUL Leuven, Belgium, 4 CHU Saint-Pierre, Brussels, Belgium, 5 UZ, Gent, Belgium, 6 Hôpitaux Iris Sud Bracops, Brussels, Belgium, 7 CHU Brugmann, Brussels, Belgium, 8 Ziekenhuis Oost-Limburg, Genk, Belgium,
9 AZ St Jan, Brugge, Belgium, 10 UZ Antwerpen, Edegem, Belgium, 11 CHU, Liège, Belgium, 12 UZ, Brussels, Belgium
The authors have no financial disclosure related to this study
Introduction: Hepatitis B (HBV) and C (HCV) infections share many epidemiological and clinical similarities but exhibit also important differences. Moreover, their epidemiological characteristics are evolving in western countries. Nationwide studies comparing representative samples of patients newly diagnosed with HBV or HCV infections have not been reported. Aim: To compare the main epidemiological, biological and histological characteristics of patients with newly diagnosed HBV or HCV infection in Belgium, and to compare their management. Methods: Data of patients with newly diagnosed HBV or HVC infection were extracted from two Belgian registries (HBsAg carriers registry, 2008-2009 and observational survey of hepatitis C, 2003-2004). Results: 705 patients (387 with HBV and 318 with HCV) were included. Compared to HCV patients, HBV patients were younger (36 vs. 44 years, p<0.0001), more frequently male (69 vs. 56%, p<0.0003), less frequently of Caucasian origin (43 vs. 86%, p<0.0001), more frequently black Africans (32 vs. 9%, p<0.0001), less frequently contaminated by transfusion or IV drug use (9 and 6% vs. 33 and 43%, respectively, p<0.0001), more frequently contaminated by sexual or familial transmission (40 and 30% vs. 1 and 1% respectively, p<0.0001). HBV patients had higher rates of normal ALT (65 vs. 36%, p<0.0001), lower rates of ALT >2ULN (15 vs. 38%, p<0.0001), and lower rates of detectable viral nucleic acid by PCR (70 vs. 84%, p<0.0001) than HCV patients. A liver biopsy was performed in 303 patients (in 29% of HBV patients and in 61% of HCV patients, p<0.0001). Twenty-five percents of the patients had extensive fibrosis or cirrhosis (F3/4) (32% of HBV patients, 21% of HCV patients, p=0.04). In multivariate analysis, significant predictors of F3/4 were: older age (p=0.003), male sex (p=0.02), HBV infection (p=0.03), ALT >2ULN (p=0.01) and activity score >2 (p=0.004). HBV patients were less frequently considered for treatment (25 vs. 47%, p<0.0001) than HCV patients. Conclusions: Newly diagnosed HBV and HCV patients disclosed different epidemiological characteristics that should be taken into account for screening. Management of HBV and HCV patients differed, HBV patients undergoing less frequently a liver biopsy and being less frequently considered for treatment..
Conclusions
1/ In Belgium, newly diagnosed HBV and HCV patients disclose different epidemiological characteristics that should be taken into account for screening.
2/ Management of HBV and HCV patients also differs, HBV patients undergoing less frequently a liver biopsy and being less frequently considered for treatment.
Introduction
Hepatitis B (HBV) and C (HCV) infections share many epidemiological and clinical similarities but exhibit also important differences. Moreover, their epidemiological characteristics are evolving in western countries. Nationwide studies comparing representative samples of patients newly diagnosed with HBV or HCV infections have not been reported.
Aim
To compare the main epidemiological, biological and histological characteristics of patients with newly diagnosed HBV or HCV infection in Belgium and to compare their management.
Methods
Data of patients with newly diagnosed HBV or HCV infection were extracted from two Belgian registries (HBsAg carriers registry, 2008-2009 and observational survey of hepatitis C, 2003-2004).
PatientsHBV patients
n=387
HCV patients
n=318
p value
Mean age (years) 36 44 <0.0001
Sex ratio (men/women) 69% / 31% 56% / 44% <0.0003
Origin
Caucasian 43% 86% <0.0001
Black African 32% 9% <0.0001
Other 25% 5% <0.0001
Risk factors for infection
Transfusion 9% 33% <0.0001
IV drug use 6% 43% <0.0001
Sexual behavior 40% 1% <0.0001
Familial transmission 30% 1% <0.0001
Histological parameters and managementBiological parameters
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Normal ALT ALT>2ULN Detectableviral nucleicacid by PCR
HBV
HCV
0%
10%
20%
30%
40%
50%
60%
70%
Biopsy performed Treatment considered
HBVHCV
0%
5%
10%
15%
20%
25%
30%
35%
F3/4
Predictors of F3/4 in multivariate analysis
Older age p=0.003
Male sex p=0.02
HBV infection p=0.03
ALT>2ULN p=0.01
Activity score >2 p=0.004