Hepatitis B care pathway in Saudi Arabia: Current situation, gaps and actions

Abstract

Hepatitis B virus (HBV) infection remains a public health problem worldwide. In this review, we aim to assess the current situation of the HBV care pathway in the Kingdom of Saudi Arabia (KSA), identify gaps/barriers therein, and recommend initiatives to be taken to improve the management of such patients. Towards this end, a literature search was conducted in PubMed and free Internet searches. Interviews with individuals and focus group discussions were held with HBV experts in KSA. Although significant improvements have been made in the past 30 years in KSA in terms of the decline in prevalence (currently estimated to be around 1.3%), the morbidity and mortality related to the disease have not shown a parallel decline. This makes HBV an important public health concern. Furthermore, poor disease awareness, low diagnosis rates, and nonadherence to therapy amplify the disease burden. There are several mandated national screening structures present; however, established protocols for those who test positive and subsequent linkage-to-care are inadequate. In the absence of a virologic cure, a concerted effort should be made to provide safe and effective lifelong treatment. This review provides recommendations to reduce the HBV disease burden in the Saudi population.

<p>The Incidence Rate of Liver Cancer in Saudi Arabia: An Observational Descriptive Epidemiological Analysis of Data from the Saudi Cancer Registry (2004–2014)</p>

“…14 A systematic review and meta-analysis for 36 published studies in Saudi Arabia from 1965 to 2013 found a 3.2% prevalence of HBV, which was slightly lower than the worldwide prevalence of 3.6%. 15 In Saudi Arabia, obesity and instances of being overweight are increasing with an overall rate of 35.5%. 16,17 The region of Riyadh is considered one of the most highly affected areas with obesity in Saudi Arabia, with a 35% prevalence of obesity.…”

HIV in the Kingdom of Saudi Arabia: Can We Change the Way We Deal with Co-Infections

“…Since HBV and HCV are endemic in KSA, there are numerous reports describing their prevalence, clinical characteristics, and sero-epidemiology. 2 However, only few reports describe HBV or HCV co-infections in HIV-positive people in the KSA ( Table 1 ). HCV infection has been frequently reported to be the most dominant co-infection in HIV-positive individuals followed by HBV.…”

Saudi Association for the Study of Liver diseases and Transplantation practice guidelines on the diagnosis and management of hepatocellular carcinoma

“…Similarly, hepatitis B vaccination has also significantly reduced the HBV infection rates in KSA. [ 51 52 53 54 ] In fact, a recent review of the hepatitis B care pathway in the country demonstrated that significant improvements had been made in the last decades. These efforts result in an estimated current HBV prevalence of approximately 1.5% in the KSA.…”

“…These efforts result in an estimated current HBV prevalence of approximately 1.5% in the KSA. [ 54 ] Although there are no formal studies on the outcomes of hepatitis B vaccination on HCC incidence, there are some suggestions that the HBV-related HCC incidence has reduced. Three newer studies done between 2011 and 2014 found higher HCV-related HCC rates compared to HBV,[ 24 55 56 ] as opposed to older studies between 1990 and 2004, where HBV was the predominant HCC etiology.…”

“…Thus, in the absence of a virologic cure, a concerted effort should be made to provide safe and effective lifelong treatment. [ 54 ]…”