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