Trends in decompensated cirrhosis and hepatocellular carcinoma among people with a hepatitis B notification in New South Wales.

Autor:	Shah SHBU; The Kirby Institute, University of New South Wales (UNSW), Sydney, NSW, Australia., Alavi M; The Kirby Institute, University of New South Wales (UNSW), Sydney, NSW, Australia., Hajarizadeh B; The Kirby Institute, University of New South Wales (UNSW), Sydney, NSW, Australia., Matthews GV; The Kirby Institute, University of New South Wales (UNSW), Sydney, NSW, Australia.; St Vincent's Hospital, Sydney, Australia., Martinello M; The Kirby Institute, University of New South Wales (UNSW), Sydney, NSW, Australia., Danta M; St Vincent's Hospital, Sydney, Australia., Amin J; Department of Health Systems and Populations, Macquarie University, Sydney, NSW, Australia., Law MG; The Kirby Institute, University of New South Wales (UNSW), Sydney, NSW, Australia., George J; Storr Liver Centre, Westmead Millennium Institute, University of Sydney and Westmead Hospital, Westmead, Australia., Valerio H; The Kirby Institute, University of New South Wales (UNSW), Sydney, NSW, Australia., Dore GJ; The Kirby Institute, University of New South Wales (UNSW), Sydney, NSW, Australia.
Jazyk:	angličtina
Zdroj:	JHEP reports : innovation in hepatology [JHEP Rep] 2022 Aug 06; Vol. 4 (10), pp. 100552. Date of Electronic Publication: 2022 Aug 06 (Print Publication: 2022).
DOI:	10.1016/j.jhepr.2022.100552
Abstrakt:	Background & Aims: Population-level trends and factors associated with HBV-related decompensated cirrhosis (DC), hepatocellular carcinoma (HCC), and liver-related mortality are crucial to evaluate the impacts of therapeutic interventions. Methods: Trends in HBV-DC and -HCC diagnoses and liver-related mortality in New South Wales, Australia, were determined through linkage of HBV notifications (1993-2017) to hospital admissions (2001-2018), mortality (1993-2018), and cancer registry (1994-2014) databases. Late HBV notification was defined as notification at or within 2 years of a DC or HCC diagnosis. Cox proportional-hazards regression and multivariable logistic regression analyses were performed to evaluate associated factors. Results: Among 60,660 people with a HBV notification, 1,276 (2.0%) DC and 1,087 (1.8%) HCC diagnoses, and 1,219 (2.0%) liver-related deaths were documented. Since the early 2000s, the number of DC and HCC diagnoses increased; however, age-standardised incidence decreased from 2.64 and 1.95 in 2003 to 1.14 and 1.09 per 1,000 person-years in 2017, respectively. Similarly, age-standardised liver mortality decreased from 2.60 in 2003 to 1.14 per 1,000 person-years in 2017. Among people with DC and HCC diagnoses, late HBV notification declined from 41% and 40% between 2001-2009 to 29% and 25% in 2010-2018, respectively. Predictors of DC diagnosis included older age (birth <1944, adjusted hazard ratio [aHR] 2.06, 95% CI 1.57-2.69), alcohol use disorder (aHR 4.82, 95% CI 3.96-5.87) and HCV co-infection (aHR 1.88, 95% CI 1.53-2.31). Predictors of HCC diagnosis included older age (birth <1944, aHR 3.94, 95% CI 2.91-5.32) and male sex (aHR 3.79, 95% CI 3.05-4.71). Conclusion: In an era of improved antiviral therapies, the risk of HBV-related liver morbidity and mortality has declined. HCV co-infection and alcohol use disorder are key modifiable risk factors associated with the burden of HBV. Lay Summary: Rising hepatitis B-related morbidity and mortality is a major public health concern. However, the development of highly effective medicines against hepatitis B virus (HBV) has brought renewed optimism for its elimination by 2030. This study shows a steady decline in HBV-related liver morbidity and mortality in New South Wales, Australia. Moreover, late hepatitis notification has also declined, allowing individuals with HBV to have access to timely antiviral treatment. Despite this, hepatitis C co-infection and alcohol use disorder are key modifiable risk factors associated with HBV disease burden. To attain the desired benefits from highly effective antiviral treatment, managing comorbidities, including hepatitis C and high alcohol use, must improve among individuals with hepatitis B. Competing Interests: ML has received research support from Merck, Bristol-Myers Squibb, Boehringer Ingelheim, Janssen-Cilag, Gilead Sciences, and ViiV HealthCare. ML has received consultancy and workshop fees from Gilead Sciences. ML has received Data Safety Monitoring Board Committee fees from Sirtex Pty Ltd. JG is on the speaker’s bureau for Gilead Sciences, Merck, Janssen, Roche, and Pharmaxis. JG is a member of advisory board for Gilead Sciences, Merck, Janssen, Bristol-Myers Squibb, AbbVie, Roche, GlaxoSmithKline, Pharmaxis and Pfizer. JG has received travel support from Gilead Sciences, Merck, Bristol-Myers Squibb, AbbVie, and Roche. GD has received research support from Gilead Sciences, Merck, and AbbVie. Other authors have no commercial relationships that might pose a conflict of interest in connection with this manuscript. GM has received research support from Gilead Sciences and AbbVie. Please refer to the accompanying ICMJE disclosure forms for further details. (© 2022 The Author(s).)
Databáze:	MEDLINE
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