Published online May 27, 2018. doi: 10.4254/wjh.v10.i5.409
Peer-review started: February 21, 2018
First decision: March 15, 2018
Revised: March 20, 2018
Accepted: April 15, 2018
Article in press: April 16, 2018
Published online: May 27, 2018
While the introduction of an effective vaccine has been highly effective in reducing the incidence and prevalence of hepatitis B virus (HBV) infection in many countries, an estimated 257 million people worldwide are still chronically infected. In 2015, WHO published guidelines for the prevention, care and treatment of persons with chronic HBV infection. These promote the use of simple, noninvasive tests to assess liver disease stage and eligibility for treatment.
Few data are currently available concerning the real-word large-scale staging and treatment of HBV patients followed in specialised outpatient services. The knowledge of the specific characteristics of patients could lead to appropriate planning for public health programs, thus contributing to the successful, efficient translation of this knowledge to management and treatment of HBV patients to eradicate HBV.
The main objective of this study was to build a regional database of patients diagnosed with chronic HBV infection in specialised outpatient services in our region to define the clinical epidemiology of HBV-infected patients in the Tuscan public health care system.
This prospective observational study is fully in line with the objectives of the National Plan for the Prevention of Viral Hepatitis, in particular with those outlining the importance of the quality of reporting system data and of the monitoring of HBV and hepatitis C virus as acute or chronic infections. This study used a cross-sectional cohort design to evaluate all patients with HBV-related chronic liver disease referred to the hepatology outpatient services of 16 hospital units from January 1, 2015, to December 31, 2015. A computerised clinical database was used to collect the main socio-demographic, clinical and treatment data for all patients with chronic HBV infection admitted at each centre. The exported file (containing the “anonymized” data) was then sent to the Regional Health Agency of Tuscany via a secure channel (SSL).
The results of this study demonstrated that 27.3% of chronic viral hepatitis patients were HBV infected. Of these HBV-infected patients, 73% were Caucasian, 21% Asian, 4% Central African, 1% North African and 1% American. Stratifying patients by age and nationality, we found that 21.7% of HBV-infected patients were aged < 34 years. Among these only 2.8% were Italian. The most represented routes of transmission were nosocomial/dental procedures (23%), mother-to-child (17%) and sexual transmission (12%). The most represented HBV genotypes were D (72%) and A (14%). Of the patients, 24.7% were HBeAg positive, and 75.3% were HBeAg negative. Of the HBV patients, 7% were anti-HDV positive. In the whole cohort, 26.9% were cirrhotic (35.8% aged < 45 years), and 47% were eligible for or currently undergoing treatment, of whom 41.9% were cirrhotic.
The informatization of clinical data and the real-word large-scale staging and treatment of these kinds of patients would allow health planners to assign specific healthcare resources to targeted populations. This observational research may provide a public health opportunity to screen and treat specific groups of patients. In particular, to eradicate HBV infection further efforts are necessary to increase vaccine coverage in immigrant populations.
Based on the data collected in the course of this investigation, it is necessary to implement a series of preventive measures and strengthen the entire care process to eliminate, or at least reduce, risk factors for HBV infection and progression toward advanced liver fibrosis stages and to adopt care protocols suitable for immigrant populations.