Abstract
Background & Aim
HBV epidemiology is highly heterogeneous and rapidly evolving worldwide: we studied
its last two-decades dynamics in a large single center cohort.
Methods
In all consecutive HBsAg-positive subjects firstly admitted (2000–2019) at the Pisa-University-Hospital
Hepatology-Referral-Center, demographic, virologic and clinical variables were analyzed
by admission decade (2000–2009 vs 2010–2019) and origin (Italian vs non-Italian natives).
Results
Of 2003, 1878 (93.7%) subjects were eligible: 1798(95.7%) with HBV-chronic [126(7%)
HDV, 72(4%) HCV, 11(0.6%) HIV co-infected] and 80(4.3%) HBV-primary infections (93.7%
Italians). Among 1589(88.4%) mono-infected, 496(31.2%) were immigrants, younger than
Italians [34.0(5.1–77.1)-52.5(10.0–87.2) years], with female prevalence [204/496(41.1%)-340/1093(31.1%);
p<0.001] increasing overtime (14.6–45.0%; p<0.001). Italians aged across decades [50.3(11.1–87.2)-56.2(10.0–86.7) years; p<0.001], HBeAg-positivity remained stable (12.3–14.5%) and acute hepatitis increased
(4.0–8.0%; p = 0.003). CHB declined [439/721(60.9%)-320/868(36.9%); p<0.001] whereas HBeAg-negative infection increased [277/626(44.2%)-538/755(71.3%);
p<0.001]. Cirrhosis declined [195/721(27.0%)-125/868(14.4%); p<0.001], except in anti-HDV-patients [93/126(73.8%); 42(45.1%) non-Italians], younger
than HBV-mono-infected (47.4–57.6 years; p<0.001).
Conclusion
Effective preventive health care policies and immigration flows account for increasing
prevalence of HBeAg-negative infection across the last two decades. Antiviral therapy
mitigated disease progression in aging Italian CHB but not in CHD patients, mainly
young immigrants, emphasizing the unmet need of effective CHD therapies; HBeAg-positive
CHB and acute hepatitis B persist in non-vaccinated Italian adults, prompting vaccination
in the elderly with risky behaviors.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Digestive and Liver DiseaseAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hepatitis B virus burden in developing countries.World J Gastroenterol. 2015 Nov 14; 21: 11941-11953
- Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013.Lancet. 2015; 386: 1546-1555
World Health Organization. Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection. March 2015 – WHO Library Cataloguing in publication data. ISBN: 978 92 4 154905 9.
- Impact of universal vaccination programmes on the epidemiology of hepatitis B: 10 years of experience in Italy.Vaccine. 2003; 21: 685-691
- EASL 2017 clinical practice guidelines on the management of hepatitis B virus infection.J Hepatol. 2017; 67: 370-398
- Polaris Observatory Collaborators. Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modelling study.Lancet Gastroenterol Hepatol. 2018; 3: 383-403
- Point-of-care screening, prevalence, and risk factors for hepatitis B infection among 3,728 mainly undocumented migrants from Non-EU countries in northern Italy.J Travel Med. 2015; 22: 78-86
- Blood-borne chronic viral infections in a large cohort of immigrants in southern Italy: a seven-centre, prospective, screening study.Travel Med Infect Dis. 2020; 35101551
- The present profile of chronic hepatitis B virus infection highlights future challenges: an analysis of the Multicenter Italian MASTER-B cohort.Dig Liver Dis. 2019; 51: 438-442
- Chronic hepatitis B virus infection in Italy during the twenty-first century: an updated survey in 2019.Eur J Clin Microbiol Infect Dis. 2021; 40: 607-614
- Low prevalence of hepatitis B and hepatitis C virus serum markers in a cohort of pregnant women from Southern Italy.Dig Liver Dis. 2017; 49: 1368-1372
- Chronic HBV infection in pregnant immigrants: a multicenter study of the Italian society of infectious and tropical diseases.New Microbiol. 2016; 39: 114-118
- The changing pattern of hepatitis B virus infection over the past three decades in Italy.Dig Liver Dis. 2005; 37: 622-627
- Influence of universal HBV vaccination on chronic HBV infection in Italy: results of a cross-sectional multicenter study.J Med Virol. 2017; 89: 2138-2143
- Natural history of chronic hepatitis B: special emphasis on disease progression and prognostic factors.J Hepatol. 2008; 48: 335-352
BOLLETTINO SEIEVA EPIDEMIOLOGIA DELLE EPATITI VIRALI ACUTE IN ITALIA. Numero 6, Aggiornamento 2019. Marzo 2020.
- The Seieva collaborating group. Effectiveness of Hepatitis B vaccination campaign in Italy: towards the control of HBV infection for the first time in a European country.Viruses. 2022 Jan 26; 14: 245
- Regression of cirrhosis during treatment with tenofovir disoproxil fumarate for chronic hepatitis B: a 5-year open-label follow-up study.Lancet. 2013; 381: 468-475
- Endpoints and new options for treatment of chronic hepatitis D.Hepatology. 2021; 74: 3479-3485
Article info
Publication history
Published online: November 18, 2022
Accepted:
November 2,
2022
Received:
August 31,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.