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Current Hepatology Reports
Published in: Current Hepatology Reports 3/2019

01-09-2019 | Hepatitis B | Hepatitis B (JK Lim, Section Editor)

Chronic Hepatitis B in US Veterans

Authors: Patrik Garren, Marina Serper

Published in: Current Hepatology Reports | Issue 3/2019

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Abstract

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.

Recent Findings

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.

Summary

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.
Literature
1.
Backus LI, Belperio PS, Loomis TP, Han SH, Mole LA. Screening for and prevalence of hepatitis B virus infection among high-risk veterans under the care of the U.S. Department of Veterans Affairs: a case report. Ann Intern Med. 2014;161(12):926–8.CrossRefPubMed
2.
Ioannou GN. Hepatitis B virus in the United States: infection, exposure, and immunity rates in a nationally representative survey. Ann Intern Med. 2011;154(5):319–28.CrossRefPubMed
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.PubMed
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. CrossRefPubMedPubMedCentral
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.CrossRef
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. CrossRef
7.
Kruse RL, Kramer JR, Tyson GL, Duan Z, Chen L, El-Serag HB, et al. Clinical outcomes of hepatitis B virus coinfection in a United States cohort of hepatitis C virus-infected patients. Hepatology (Baltimore, Md). 2014;60(6):1871–8.CrossRef
8.
Chayanupatkul M, Omino R, Mittal S, Kramer JR, Richardson P, Thrift AP, et al. Hepatocellular carcinoma in the absence of cirrhosis in patients with chronic hepatitis B virus infection. J Hepatol. 2017;66(2):355–62 •.CrossRefPubMed
9.
El-Serag HB, Richardson PA, Everhart JE. The role of diabetes in hepatocellular carcinoma: a case-control study among United States Veterans. Am J Gastroenterol. 2001;96(8):2462–7.CrossRefPubMed
10.
• Kushner T, Serper M, Kaplan DE. Delta hepatitis within the Veterans Affairs medical system in the United States: prevalence, risk factors, and outcomes. J Hepatol. 2015;63(3):586–92 Important study identifying Delta Hepatitis as an risk factor for hepatocellular carcinoma. CrossRefPubMedPubMedCentral
11.
Hunt CM, Beste LA, Lowy E, Suzuki A, Moylan CA, Tillmann HL, et al. Veterans health administration hepatitis B testing and treatment with anti-CD20 antibody administration. World J Gastroenterol. 2016;22(19):4732–40 •.CrossRefPubMedPubMedCentral
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. CrossRefPubMed
13.
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. CrossRefPubMed
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. CrossRef
16.
•• Serper M, Choi G, Forde KA, Kaplan DE. Care delivery and outcomes among US veterans with hepatitis B: a national cohort study. Hepatology (Baltimore, MD). 2016;63(6):1774–82 National cohort study highlighting critical gaps in the Cascade of care for HBV. CrossRef
17.
Wu Y, Johnson KB, Roccaro G, Lopez J, Zheng H, Muiru A, et al. Poor adherence to AASLD guidelines for chronic hepatitis B management and treatment in a large academic medical center. Am J Gastroenterol. 2014;109(6):867–75.CrossRefPubMedPubMedCentral
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. CrossRefPubMed
Metadata
Title
Chronic Hepatitis B in US Veterans
Authors
Patrik Garren
Marina Serper
Publication date
01-09-2019
Publisher
Springer US
Published in
Current Hepatology Reports / Issue 3/2019
Electronic ISSN: 2195-9595
DOI
https://doi.org/10.1007/s11901-019-00479-9

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