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CMAJ Open. 2019 Oct 22;7(4):E610-E617. doi: 10.9778/cmajo.20190103. Print 2019 Oct-Dec.

Epidemiologic and clinical features of chronic hepatitis B virus infection in 8 Canadian provinces: a descriptive study by the Canadian HBV Network.

Author information

1
Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man. cscoffin@ucalgary.ca.
2
Cumming School of Medicine (Coffin, Lethebe, Congly, Haylock-Jacobs), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji, Ko), Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cooper), University of Ottawa, Ottawa Hospital Research Institute; Division of Gastroenterology (Kelly), Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Doucette, Ma), University of Alberta, Edmonton, Alta.; Division of Gastroenterology (P. Wong), Department of Medicine, McGill University, Royal Victoria Hospital, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Department of Medicine (D. Wong, Janssen, Fung), University of Toronto, Toronto Centre for Liver Disease, Toronto, Ont.; Department of Medicine (A. Wong), University of Saskatchewan; Regina General Hospital (Ukabam), Regina, Sask.; Bailey Health Clinic (Bailey), Edmonton, Alta.; Department of Medicine (Tsoi), McMaster University, St. Joseph's Healthcare, Hamilton, Ont.; Vancouver Infectious Diseases Centre (Conway), Vancouver, BC; Division of Infectious Diseases (Barrett), Dalhousie University, Halifax, NS; Faculty of Medicine (Michalak), Memorial University of Newfoundland, St. John's, Nfld.; Department of Internal Medicine (Minuk, Uhanova, Miles, Kaita), University of Manitoba; National Microbiology Laboratory (Osiowy), Public Health Agency of Canada, Winnipeg, Man.

Abstract

BACKGROUND:

Published Canadian epidemiologic data on hepatitis B virus (HBV) infection include single-centre studies or are focused on Indigenous populations. We performed a study to characterize the demographic and clinical features, liver disease status and treatment of people with chronic hepatitis B in Canada.

METHODS:

In this descriptive, opportunistic, cross-sectional study, available data for people known to be monoinfected with HBV were collected by the Canadian HBV Network from existing clinical databases, with support from the National Microbiology Laboratory, Public Health Agency of Canada. Data were collected in all provinces with the exception of New Brunswick and Newfoundland and Labrador. We analyzed the data using parametric and nonparametric statistical methods, with a significance level of p < 0.05.

RESULTS:

In the 9380 unique patient records reviewed, the median age was 48 years, and 5193 patients (55.4%) were male. Ethnicity information was available for 7858 patients, of whom 5803 (73.8%) were Asian, 916 (11.6%) were black and 914 (11.6%) were white. Most of those tested (5556/6796 [81.8%]) were negative for HBV e-antigen, and most of those with fibrosis data (3481/4260 [81.7%]) had minimal liver fibrosis, with more advanced fibrosis noted in older people (> 40 yr). Of the 980 patients with genotype data, 521 (53.2%) had genotype B or C infection. Most of the 9241 patients with known confirmed treatment status received tenofovir disoproxil fumarate (1655 [17.9%]), lamivudine (1434 [15.5%]) or entecavir (548 [5.9%]).

INTERPRETATION:

Based on available data, Canadian patients with chronic hepatitis B are predominantly Asian and negative for HBV e-antigen, and have genotype B or C infection. Interprovincial variations were noted in antiviral treatment regimen. This multicentre nationwide study provides data regarding patients with chronic hepatitis B and may inform future studies on the epidemiologic features of HBV infection in Canada.

Conflict of interest statement

Competing interests: Carla Coffin reports investigator-initiated research grants/research materials from GlaxoSmithKline, Gilead Sciences, Arbutus Biopharma and Bristol-Myers Squibb, and educational grants from Merck, Gilead Sciences and Janssen Pharmaceutica. She is on the advisory board for Merck, Gilead Sciences and GlaxoSmithKline, and the Trial Guidance and Publication Committee for Spring Bank Pharmaceuticals, and has participated as a local site principal investigator in clinical trials for Gilead Sciences, Spring Bank Pharmaceuticals, Transgene and Janssen Pharmaceutica. Alnoor Ramji reports clinical investigator grants from Allergan, Arbutus Biopharma, Gilead Sciences, Janssen Pharmaceutica, Intercept Pharmaceuticals, Norvartis, Merck, Spring Bank Pharmaceuticals and Assembly Biosciences; personal fees from AbbVie, Gilead Sciences, Intercept Pharmaceuticals, Lupin and Merck; and grants from AbbVie, Celgene Corporation, Gilead Sciences, Janssen Pharmaceutica, Intercept Pharmaceuticals and Merck. Karen Doucette reports a grant from Gilead Sciences. Keith Tsoi reports personal fees from Gilead Sciences, Merck, AbbVie and Intercept Pharmaceuticals, and nonfinancial support from Gilead Sciences. Brian Conway reports grants and honoraria from AbbVie, Gilead Sciences, Indivior, Merck and Viiv Healthcare. He has acted as a consultant for these companies. Lisa Barrett reports grants from AbbVie and personal fees from AbbVie, Bristol-Myers Squibb, Gilead Sciences and ViiV Healthcare. Stephen Congly reports grants from Allergan, Gilead Sciences, Genfit, Boehringer Ingelheim and Bristol-Myers Squibb, and personal fees from Allergan. Edward Tam reports grants from AbbVie, Gilead Sciences, Merck, Intercept Pharmaceuticals and Janssen Pharmaceutica, and personal fees from AbbVie, Bristol-Myers Squibb, Gilead Sciences, Merck, Intercept Pharmaceuticals and Janssen Pharmaceutica. David Wong reports other funding from AbbVie, Merck and Gilead Sciences. Alex Wong reports grants and personal fees from Gilead Sciences. Harry Janssen reports grants from AbbVie, Bristol-Myers Squibb, Gilead Sciences, Janssen Pharmaceutica, MedImmune, Merck and Roche, and personal fees from AbbVie, Benitec Biopharma, Bristol-Myers Squibb, Gilead Sciences, Janssen Pharmaceutica, MedImmune, Roche, Arbutus Biopharma and Vir Biotechnology. Scott Fung reports speaking and teaching fees from Gilead Sciences and Bristol-Myers Squibb, and consulting fees from Gilead Sciences. No other competing interests were reported.

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