©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Differing profiles of people diagnosed with acute and chronic hepatitis B virus infection in British Columbia, Canada
Mawuena Binka, Zahid A Butt, Stanley Wong, Mei Chong, Jane A Buxton, Nuria Chapinal, Amanda Yu, Maria Alvarez, Maryam Darvishian, Jason Wong, Gina McGowan, Mikhail Torban, Mark Gilbert, Mark Tyndall, Mel Krajden, Naveed Z Janjua
Mawuena Binka, Zahid A Butt, Stanley Wong, Mei Chong, Jane A Buxton, Nuria Chapinal, Amanda Yu, Maria Alvarez, Maryam Darvishian, Jason Wong, Mark Gilbert, Mark Tyndall, Mel Krajden, Naveed Z Janjua, British Columbia Centre for Disease Control, Vancouver BC V5Z4R4, Canada
Mawuena Binka, Zahid A Butt, Stanley Wong, Jane A Buxton, Maryam Darvishian, Jason Wong, Mark Gilbert, Mark Tyndall, Naveed Z Janjua, School of Population and Public Health, University of British Columbia, Vancouver BC V6T1Z3, Canada
Gina McGowan, Mikhail Torban, Division of Population and Public Health, Ministry of Health, Victoria BC V8W9P1, Canada
Mel Krajden, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver BC V6T1Z2, Canada
Author contributions: Janjua NZ conceptualized the study; Janjua NZ, Chong M and Wong S contributed to study design; Binka M and Janjua NZ contributed to data analysis and interpretation, and writing of article; Butt ZA, Wong S, Chong M, Chapinal N, Yu A, Alvarez M, McGowan G, Torban M, Darvishian M and Janjua NZ contributed to data acquisition; Butt ZA, Buxton JA, Wong J, McGowan G, Torban M, Gilbert M, Tyndall M, Krajden M and Janjua NZ contributed to editing, reviewing and final approval of article.
Supported by the BC Centre for Disease Control and the Canadian Institutes of Health Research, No. NHC–142832 and No. PHE-141773.
Institutional review board statement: The Behavioral Research Ethics Board of the University of British Columbia approved this study (H14-01649).
Conflict-of-interest statement: Mel Krajden reports receiving grant funding via his institution from Roche Molecular Systems, Boehringer Ingelheim, Merck, Siemens Healthcare Diagnostics and Hologic Inc. No other authors have conflicts of interest to declare.
Data sharing statement: Data are available from the BC Centre for Disease Control Institutional Data Access for researchers who meet the criteria for access to confidential data.
STROBE statement: The manuscript was prepared according to the STROBE Statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Naveed Z Janjua, MBBS, MSc, DrPH, BC Centre for Disease Control, 655 West 12th Avenue, Vancouver BC V5Z4R4, Canada. email@example.com
Telephone: +1-604-7072514 Fax: +1-604-7072401
Received: January 13, 2018
Peer-review started: January 13, 2018
First decision: February 5, 2018
Revised: February 21, 2018
Accepted: March 3, 2018
Article in press: March 3, 2018
Published online: March 21, 2018
To describe the characteristics of people diagnosed with acute and chronic hepatitis B virus (HBV) infection in British Columbia (BC).
We used data from the BC Hepatitis Testers Cohort (BC-HTC), which includes all individuals tested for hepatitis C virus (HCV) or human immunodeficiency virus (HIV) or those diagnosed with HBV or active tuberculosis in BC since 1990. These data were integrated with prescription drug, medical visit, hospitalization and mortality data. HBV cases were classified as acute or chronic according to provincial guidelines. We compared characteristics of individuals by HBV infection group (acute, chronic and negative). Factors associated with acute or chronic HBV infection were assessed with multinomial logistic regression models in comparison to the HBV negative group.
46498 of the 1058056 eligible BC-HTC participants were diagnosed with HBV infection. 4.3% of HBV positive individuals were diagnosed with acute HBV infections while 95.7% had chronic infections. Problematic alcohol use, injection drug use, and HIV or HCV co-infection were more common among individuals diagnosed with acute HBV compared to those with chronic infections and HBV negative individuals. In multivariable multinomial logistic regression models, we observed significant associations between acute or chronic HBV diagnosis and being male, age at HBV diagnosis or birth cohort, South and East Asian ethnicity, HCV or HIV infection, and injection drug use. The odds of acute HBV decreased with increasing age among people who inject drugs, while the opposite was true for chronic HBV. Persons with acute HBV were predominantly White (78%) while those with chronic HBV were mostly East Asian (60%). Relative to Whites, East Asians had 12 times greater odds of being diagnosed with chronic HBV infection. These odds increased with increasing socioeconomic deprivation.
Differences in the profiles of people diagnosed with acute and chronic HBV infection necessitate differentiated screening, prevention, care and treatment programs.
Core tip: Substance use, major mental illness and hepatitis C virus or human immunodeficiency virus co-infection were more common among individuals with acute HBV compared with those diagnosed with chronic hepatitis B virus (HBV). Acute HBV was mainly diagnosed in the White population, while chronic HBV was mostly diagnosed among people with East Asian ethnicity. The risk of acute HBV was highest among the younger population who injected drugs, while the risk of chronic HBV infection was highest among East Asian people with lower socioeconomic status. Differences in the profiles of people diagnosed with acute and chronic HBV suggest the need for different interventions for both population groups.