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Updated: Feb 28, 2026
Author Spotlight: Advancements and Challenges in Hepatitis B Virus Detection
Published on: December 15, 2023
Hepatitis B virus testing and linkage to care in a Canadian urban tertiary referral centre: a retrospective cohort
Keith C K Lau1, Abdel Aziz Shaheen1, Alexander A Aspinall1
1Affiliations: Calgary Liver Unit (Lau, Shaheen, Aspinall, Congly, Borman, Jayakumar, Eksteen, Lee, Stinton, Swain, Burak, Coffin), Division of Gastroenterology and Hepatology, Department of Medicine; Department of Microbiology, Immunology and Infectious Diseases (Lau, Coffin), Cumming School of Medicine, University of Calgary; Alberta Health Services (Ricento, Qureshi), Calgary, Alta.
Insights
Many individuals testing positive for hepatitis B surface antigen (HBsAg) in Calgary did not receive recommended follow-up tests or specialist care. This highlights the need for improved chronic hepatitis B management to meet global elimination goals.
Area of Science:
- Hepatology
- Public Health
- Infectious Diseases
Background:
- Chronic hepatitis B virus (HBV) infection is a persistent public health issue in North America, largely due to immigration.
- Universal vaccination has not eliminated HBV, necessitating ongoing surveillance and management strategies.
Purpose of the Study:
- To determine the number of individuals with a positive hepatitis B surface antigen (HBsAg) test in Calgary.
- To assess the uptake of recommended laboratory tests and specialist consultations for HBsAg-positive individuals.
Main Methods:
- Retrospective analysis of laboratory and administrative data from Calgary Zone (2014).
- Inclusion of adults (age > 18 years) with a positive HBsAg test.
- Extraction of demographic, laboratory, and referral data within 6 months of HBsAg positivity.
Main Results:
- 1214 HBsAg-positive individuals identified; median age 44 years.
- High rates of alanine aminotransferase testing (98.2%), but lower rates for HBV DNA (56.2%) and HBV e antigen/antibody (51.9%/11.9%).
- Only 11.9% received anti-HBV treatment, and 32.1% were referred to a hepatologist.
Conclusions:
- A significant proportion of HBsAg-positive individuals in Calgary did not receive recommended laboratory assessments and specialist care.
- These findings underscore the need for enhanced public health initiatives for chronic HBV screening and follow-up in Canada.
- Improved management is crucial for achieving the World Health Organization's viral hepatitis elimination targets by 2030.
Background:
Despite universal vaccination, chronic hepatitis B virus (HBV) infection remains a public health concern in North America owing to immigration. We aimed to characterize the number of people with a positive result of testing for HBV surface antigen (HBsAg) in Calgary, a large urban Canadian health care region, and to assess whether recommended laboratory tests and specialist consultation were done for those identified as HBsAg-positive.
Methods:
Based on laboratory and Alberta Health Services administrative data, we identified all adults (age > 18 yr) with a positive HBsAg test result from Jan. 1 to Dec. 31, 2014 within the Calgary Zone. Demographic and relevant laboratory data were extracted within 6 months of a positive HBsAg test result, and referral to hepatology (2011-2014) was identified from data on referral to a centralized clinic. Parametric and nonparametric statistical methods were used for analyses.
Results:
We identified 1214 HBsAg-positive people (584 women [48.1%]; median age 44 [interquartile range (IQR) 36-55] yr). A total of 1192 people (98.2%) had alanine aminotransferase testing (median level 23 [IQR 16-34] U/L; 117 [9.8%] with elevated levels), 682 (56.2%) had testing for HBV DNA (median level 2.8 [IQR 2.1-3.8] logIU/mL), 630 (51.9%) had HBV e antigen testing (negative result in 548 [87.0%]), and 145 (11.9%) had HBV e antibody testing (positive result in 111 [76.6%]). Overall, 144 people (11.9%) received anti-HBV treatment, and 390 (32.1%) were referred to a hepatologist.
Interpretation:
Many HBsAg-positive people in Calgary did not receive the recommended laboratory assessments. The results highlight the necessity of continual public health efforts to screen for chronic HBV infection in Canada and to ensure adequate follow-up in order to reach the World Health Organization's goal of viral hepatitis elimination by 2030.
