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
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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.
