Chronic Hepatitis B in US Veterans
- 10 Downloads
Purpose of Review
This review summarizes recent data on chronic hepatitis B virus (HBV) epidemiology, issues in special populations undergoing immunosuppressive and hepatitis C virus (HCV) direct-acting antiviral (DAA) therapy, and describes care delivery, adherence to guideline-recommended care, and barriers to access to care and high-quality care for chronic HBV.
Chronic HBV is present in up to 1% of veterans and is more than in the general US population. HBV is associated with more advanced liver disease in HCV, HIV, and delta hepatitis co-infection. Recent data on HBV reactivation show a substantial risk of reactivation with anti-CD20 antibodies, no documented cases of reactivation with anti-tumor necrosis factor (anti-TNF) therapy, and a low risk of reactivation with HCV DAA therapy. Adherence to guideline-recommended care for HBV is suboptimal for many quality indicators.
Important studies in HBV epidemiology, long-term outcomes, and care delivery practices have been conducted in the VA. Future studies should prospectively investigate how to improve guideline-recommended care for HBV.
KeywordsHepatitis delta Hepatocellular carcinoma Cirrhosis Hepatitis B epidemiology Care quality Hepatitis B reactivation
Compliance with Ethical Standards
Conflict of Interest
Patrik Garren declares no potential conflicts of interest. Marina Serper reports consulting fees from BioVie, Inc. outside the submitted work.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 3.Weinbaum CM, Williams I, Mast EE, Wang SA, Finelli L, Wasley A, et al. Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR Recomm Rep. 2008;57(RR-8):1–20.Google Scholar
- 4.• Noska AJ, Belperio PS, Loomis TP, O'Toole TP, Backus LI. Prevalence of human immunodeficiency virus, hepatitis C virus, and hepatitis B virus among homeless and nonhomeless United States Veterans. Clin Infect Dis. 2017;65(2):252–8 Important retrospective study identifying homelessness as a risk factor for HBV among veterans. CrossRefGoogle Scholar
- 5.Bhattacharya D, Tseng CH, Tate JP, Lo Re V 3rd, Gibert CL, Butt AA, et al. Isolated hepatitis B core antibody is associated with advanced hepatic fibrosis in HIV/HCV infection but not in HIV infection alone. Journal of acquired immune deficiency syndromes (1999). 2016;72(1):e14–7.CrossRefGoogle Scholar
- 6.•• Beste LA, Leipertz SL, Green PK, Dominitz JA, Ross D, Ioannou GN. Trends in burden of cirrhosis and hepatocellular carcinoma by underlying liver disease in US veterans, 2001–2013. Gastroenterology. 2015;149(6):1471–82.e5 quiz e17–8. Important study regarding the prevalence and trends in advanced liver disease from all causes, including HBV, in the veteran population. CrossRefGoogle Scholar
- 12.• Shah R, Ho EY, Kramer JR, Richardson P, Sansgiry S, El-Serag HB, et al. Hepatitis B virus screening and reactivation in a national VA cohort of patients with inflammatory bowel disease treated with tumor necrosis factor antagonists. Digestive diseases and sciences. 2018;63(6):1551–7 Informative study showing the current use of anti- tumor necrosis factor therapy, HBV screening rates and reactivation. CrossRefGoogle Scholar
- 13.US Food and Drug Administration. FDA Drug Safety Communication: FDA warns about the risk of hepatitis B reactivating in some patients treated with direct-acting antivirals for hepatitis C. 2016. https://www.fda.gov/Drugs/DrugSafety/ucm522932.htm, Accessed December 31st, 2018.
- 14.•• Serper M, Forde KA, Kaplan DE. Rare clinically significant hepatic events and hepatitis B reactivation occur more frequently following rather than during direct-acting antiviral therapy for chronic hepatitis C: Data from a national US cohort. J Viral Hepat. 2018;25(2):187–97 National cohort study, which provides the prevalence of HBV reactivations, hepatitis, and adverse events with HCV DAA therapy. CrossRefGoogle Scholar
- 15.•• Belperio PS, Shahoumian TA, Mole LA, Backus LI. Evaluation of hepatitis B reactivation among 62,920 veterans treated with oral hepatitis C antivirals. Hepatology (Baltimore, Md). 2017;66(1):27–36 National cohort study, which provides the prevalence of HBV reactivations, hepatitis, and adverse events with HCV DAA therapy. CrossRefGoogle Scholar
- 18.• Kushner T, Lam R, Gray DL, Kaplan DE, Serper M. Identifying patient and provider-specific gaps in care among patients with hepatitis B. Journal of clinical gastroenterology. 2017;51(10):900–6 Multi-center retrospective study of factors associated with gaps in appropriate follow-up testing and clinical care for HBV. CrossRefGoogle Scholar