Highly dynamic changes of regional HBV epidemiology over two decades

Gabriele Ricco; Barbara Coco; Piero Colombatto; Filippo Oliveri; Daniela Cavallone; Patrizia Bleve; Barbara Vianello; Veronica Romagnoli; Antonio Salvati; Lidia Surace; Ferruccio Bonino; Maurizia Rossana Brunetto

doi:10.1016/j.dld.2022.11.003

Highly dynamic changes of regional HBV epidemiology over two decades

Dig Liver Dis. 2023 Apr;55(4):519-526. doi: 10.1016/j.dld.2022.11.003. Epub 2022 Nov 18.

Affiliations

¹ Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy.
² Institute of Biostructure and Bioimaging, National Research Council, Via De Amicis 95, 80145 Naples, Italy.
³ Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy; Institute of Biostructure and Bioimaging, National Research Council, Via De Amicis 95, 80145 Naples, Italy. Electronic address: maurizia.brunetto@unipi.it.

PMID: 36404234
DOI: 10.1016/j.dld.2022.11.003

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: Chronic hepatitis B; Chronic hepatitis D; HBV and migration; HBV epidemiology; HBV vaccine; HDV epidemiology.

MeSH terms

Adult
Aged
Female
Hepatitis B Surface Antigens
Hepatitis B e Antigens
Hepatitis B virus
Hepatitis B* / epidemiology
Hepatitis B, Chronic* / epidemiology
Humans
Liver Cirrhosis / epidemiology

Substances

Hepatitis B e Antigens
Hepatitis B Surface Antigens