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Prevalence of Cirrhosis/Advanced Fibrosis Among HBsAg-Negative and HBcAb-Positive US Adults: A Nationwide
Shuai-Wen Huang1,2, Chen Chen3, Hong-Yan Kong1,2
1Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Insights
Cirrhosis is often overlooked in hepatitis B surface antigen-negative/hepatitis B core antibody-positive adults. This population has a 3.76% prevalence of cirrhosis/advanced fibrosis, highlighting the need for screening.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Hepatitis B virus (HBV) infection is a global health concern.
- Cirrhosis evaluation can be overlooked in individuals who are hepatitis B surface antigen-negative (HBsAg-negative) but hepatitis B core antibody-positive (HBcAb-positive).
- This demographic represents a significant population at risk for advanced liver disease.
Purpose of the Study:
- To determine the prevalence of cirrhosis and advanced fibrosis among HBsAg-negative/HBcAb-positive adults in the United States.
- To identify risk factors and guide clinical screening strategies for this population.
Main Methods:
- Utilized data from the National Health and Nutrition Examination Survey (NHANES) from 2001-2018.
- Included 3115 US adults who were HBsAg-negative and HBcAb-positive with available data.
- Assessed liver fibrosis using the Fibrosis-4 (FIB-4) and aspartate aminotransferase to platelet ratio index (APRI) scores.
Main Results:
- The HBsAg-negative/HBcAb-positive population constituted 4.46% of US adults, approximately 9.87 million individuals.
- The weighted prevalence of cirrhosis/advanced fibrosis was 3.76% (371,112 individuals) among this group, as determined by FIB-4.
- Cirrhosis prevalence was higher in those who were hepatitis B surface antibody-negative (HBsAb-negative) (6.28%) compared to HBsAb-positive individuals (3.08%).
Conclusions:
- A significant proportion (3.76%) of HBsAg-negative/HBcAb-positive US adults have cirrhosis or advanced fibrosis.
- These findings underscore the critical need for targeted cirrhosis screening in this population.
- Particular attention should be given to HBsAb-negative individuals within this cohort due to higher observed fibrosis rates.
Introduction:
Evaluation of cirrhosis appears to be easily overlooked in the clinic for the HBsAg-negative (hepatitis B surface antigen-negative) and HBcAb-positive (hepatitis B core antibody-positive) population. Herein, we determine the prevalence of cirrhosis/advanced fibrosis among HBsAg-negative/HBcAb-positive US adults.
Methods:
Data came from the National Health and Nutrition Examination Survey (NHANES) 2001-2018. A total of 3115 HBsAg-negative/HBcAb-positive US adults were enrolled in this study. We assessed cirrhosis by using the Fibrosis-4 (FIB-4) and aspartate aminotransferase to platelet ratio index (APRI) score.
Results:
Out of 50,201 NHANES adults, 45,087 were tested for HBcAb/HBsAg, of whom 3115 met the inclusion criteria (HBsAg-negative/HBcAb-positive with available data for FIB-4/APRI). The weighted proportion of HBsAg-negative/HBcAb-positive among US adults was 4.46% (95% CI 4.17-4.75%), affecting 9.87 million US adults. According to the results of the FIB-4, the weighted prevalence of cirrhosis/advanced fibrosis among HBsAg-negative/HBcAb-positive US adults was 3.76% (95% CI 2.80-4.72%), which corresponds to 371,112 (95% CI 276,360-465,864) HBsAg-negative/HBcAb-positive American adults who had already developed cirrhosis. Among those, cirrhosis/advanced fibrosis in the HBsAb-negative (hepatitis B surface antibody) group (6.28%, 95% CI 4.10-8.45%) was significantly higher than in the HBsAb-positive group (3.08%, 95% CI 2.07-4.08%). Results were similar when APRI was used.
Conclusion:
According to the FIB-4, 3.76% of HBsAg-negative and HBcAb-positive US adults had cirrhosis/advanced fibrosis, much higher than in the general population of the USA. Our data highlight the importance of cirrhosis screening in the HBsAg-negative/HBcAb-positive population to prevent advanced liver disease, especially in those who are HBsAb-negative.
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