An Aging Population of Chronic Hepatitis B With Increasing Comorbidities: A Territory‐Wide Study From 2000 to 2017

Abstract

Patients with chronic hepatitis B (CHB) are aging because of improved survival under better health care. This has an important implication on the choice of antiviral treatment (AVT), given that long‐term safety would be a concern in the presence of multiple comorbidities. We aimed to determine the prevalence of key comorbidities and concomitant medications in a territory‐wide CHB cohort in Hong Kong in 2000‐2017. CHB patients who have been under the care at primary, secondary, and tertiary medical centers in the public sector were identified through the Clinical Data Analysis and Reporting System of the Hospital Authority, Hong Kong. The demographics and prevalence of key comorbidities, including diabetes mellitus, hypertension, chronic kidney disease, osteopenia/osteoporosis based on diagnosis codes, relevant medications, and/or laboratory parameters, were determined according to CHB patients’ first appearance in four time periods: 2000‐2004, 2005‐2009, 2010‐2013, and 2014‐2017. In the final analysis, 135,395 CHB patients were included; the mean age increased with time: 41 ± 15 years in 2000‐2004; 46 ± 17 years in 2005‐2009; 51 ± 16 years in 2010‐2013; and 55 ± 15 years in 2014‐2017. There was a trend of increasing prevalence of several common comorbidities over the four periods: hypertension 25.5%, 23.8%, 27.2%, and 28.6%; diabetes mellitus 10.6%, 12.5%, 16.1%, and 20.1%; cardiovascular disease 12.5%, 16.9%, 20.9%, and 22.2%; and malignancy 7.0%, 13.2%, 17.3%, and 23.6%, respectively (all P < 0.001). Conclusion: CHB patients are getting older with increasing prevalence of common comorbidities. These comorbidities should be taken into account when choosing AVT.

The safety of stopping nucleos(t)ide analogue treatment in patients with HBeAg‐negative chronic hepatitis B

“…We performed a territory‐wide registry cohort study using data from the Clinical Data Analysis and Reporting System of the Hospital Authority, Hong Kong. It covers the electronic medical records, use of medications and laboratory results from all public hospitals and clinics in Hong Kong and represents data of approximately 80% of the local population …”

Review article: current gaps and opportunities in HBV prevention, testing and linkage to care in the United States—a call for action

“…Patients with cirrhosis should receive additional surveillance with endoscopy and prothrombin time (PT) and international normalised ratio, especially for those who have had a history of variceal gastrointestinal bleeding. The CHB population in the US and elsewhere have also aged significantly in the past decade with increasing non‐liver comorbidity and thus introducing additional complexities to the long‐term management of CHB patients 10,109 …”

Review article: clinical pharmacology of current and investigational hepatitis B virus therapies

“…Also, the following diseases increased significantly in those years ( P < .001): cirrhosis (12.6%‐24.6%), decompensated cirrhosis (1.1%‐7.9%), HCC (4.9%‐9.1%), diabetes (4.9%‐22.9%), hypertension (12.3%‐36.1%) and chronic kidney disease (4.4%‐19.7%) . Comparable findings were observed in a large patient cohort in Hong Kong . Given the increase in age‐associated conditions in persons with HBV, providers must remain vigilant to the identification and management of potential drug‐drug interactions (DDI) between HBV therapies and medications used to treat these comorbidities, as well as potential alterations in the pharmacokinetics of HBV therapies in the aging HBV population.…”

“…6 Comparable findings were observed in a large patient cohort in Hong Kong. 10 Given the increase in age-associated conditions in persons with HBV, providers must remain vigilant to the identification and management of potential drug-drug interactions (DDI) between HBV therapies and medications used to treat these comorbidities, as well as potential alterations in the pharmacokinetics of HBV therapies in the aging HBV population. There are few DDI with current therapies, pegylated-interferon alfa (peg-IFN-α) and nucleos(t)ide analogues (NA).…”