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Unchanging prevalence of late presentation to care among patients with chronic hepatitis B
Stephen N Wong1,2, Mildred L Chua-Tan3, Maria Aloiza Hadloc3
1Department of Medicine, Chinese General Hospital and Medical Center, #286 Blumentritt Street, Manila, Metro Manila, Philippines. snwong@ust.edu.ph.
Insights
A significant portion of chronic hepatitis B patients are diagnosed late, presenting with advanced liver disease. Male gender, older age, and alcohol misuse are key factors associated with delayed diagnosis, highlighting the need for universal screening.
Area of Science:
- Hepatology
- Viral Hepatitis
- Public Health
Background:
- A consensus defines delayed hepatitis B virus (HBV) diagnosis by presentation with late-stage (hepatocellular carcinoma, decompensated cirrhosis) or advanced-stage (fibrosis ≥3) disease.
- Chronic HBV (CHB) infection affects millions globally, with diagnosis timing significantly impacting patient outcomes.
Purpose of the Study:
- To determine the prevalence of late and advanced stage presentation among CHB patients.
- To identify factors associated with late and advanced stage presentation in CHB patients.
Main Methods:
- Analysis of consecutive CHB patients diagnosed between January 2007 and December 2018.
- Categorization of patients into 'timely HBV diagnosis,' 'presentation with late stage,' and 'presentation with advanced stage' groups.
- Comparison of demographic, clinical, and laboratory factors between groups.
Main Results:
- 17.6% of CHB patients presented with late-stage disease, and 8.6% presented with advanced-stage disease.
- Late or advanced stage presentation was associated with male gender, older age, diabetes, alcohol misuse, and abnormal liver chemistries (low albumin, high AST, ALT, INR).
- Multivariate analysis identified male gender, older age, and alcohol misuse as independent predictors of late or advanced stage presentation.
Conclusions:
- Approximately a quarter of CHB patients exhibit significant liver injury at initial diagnosis.
- The consistent prevalence of late/advanced stage presentation over 12 years underscores the critical need for universal HBV screening, especially in endemic regions.
Background And Study Aims:
A recent consensus defines a delay in hepatitis B (HBV) diagnosis as presentation with late (hepatocellular carcinoma or decompensated cirrhosis) or advanced (fibrosis ≥ 3) stage disease. We aimed to determine the prevalence of late and advanced stage presentation among chronic HBV (CHB) patients and to determine factors associated with late and advanced stage presentation.
Methods:
Consecutive CHB patients seen from 1 January 2007 to 31 December 2018 were included and analyzed on January 2019. Time periods were divided into 2 periods (2007-2012 vs. 2013-2018). Patients were also divided into "Presentation with late stage" and "Presentation with advanced stage," and compared with "timely HBV diagnosis."
Results:
Out of the 782 patients, 138 (17.6%) presented with late stage while 67 (8.6%) presented with advanced stage, with no difference between the 2 time periods. Compared to patients with "timely HBV diagnosis," presentation with either late or advanced stage was more likely to be male, older, and diabetic patients, resorting to alcohol misuse and having abnormal liver chemistries (low albumin, high aspartate aminotransferase [AST], alanine aminotransferase [ALT], and international normalized ratio [INR]). Presentation with late stage liver disease was also associated with hepatitis B e antigen (HBeAg)-negative status and no family history of HBV. On multivariate analysis, male gender, older age, and alcohol misuse were associated with presentation with either late or advanced stage liver disease.
Conclusions:
A quarter of CHB patients already have significant liver injury at the time of initial HBV diagnosis. The fact that presentation with late or advanced disease has not changed in 12 years emphasizes the importance of universal screening in endemic countries.
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