How to control highly endemic hepatitis B in Asia

Shan, Shan; Cui, F Q; Jia, Jidong

doi:10.1111/liv.13625

Cited by 32 publications

(30 citation statements)

References 35 publications

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“…In Asia-Pacific, China accounts for a large proportion of the regional burden of viral hepatitis, particularly HBV, with prevalence in 2018 of more than 80 million estimated chronic infections. 4 Nevertheless, the country is moving towards elimination of viral hepatitis 4 via a universal HBV vaccination programme in infants and mandatory screening of blood products for HBV and HCV, 5 and has exceeded WHO's Western Pacific regional target for HBV vaccination and reduction of HBsAg prevalence in children younger than 5 years. 4 According to a 2015 systematic review, 6 the estimated HBsAg endemicity in mainland China decreased from 14·0% in 1957-89 to 5·4% in 1990-2013.…”

Section: Viral Hepatitis Hepatitis B D and Cmentioning

confidence: 99%

Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

Sarin

Kumar

Eslam

et al. 2020

The Lancet Gastroenterology & Hepatology

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389

303

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The Asia-Pacific region is home to more than half of the global population and accounted for 62·6% of global deaths due to liver diseases in 2015. 54·3% of global deaths due to cirrhosis, 72·7% of global deaths due to hepatocellular carcinoma, and more than two-thirds of the global burden of acute viral hepatitis occurred in this region in 2015. Chronic hepatitis B virus (HBV) infection caused more than half of the deaths due to cirrhosis in the region, followed by alcohol consumption (20·8%), non-alcoholic fatty liver disease (NAFLD; 12·1%), and chronic infection with hepatitis C virus (HCV; 15·7%). In 2015, HBV accounted for about half the cases of hepatocellular carcinoma in the region. Preventive strategies for viral hepatitis-related liver disease include increasing access to clean drinking water and sanitation. HBV vaccination programmes for neonates have been implemented by all countries, although birthdose coverage is extremely suboptimal in some. Availability of screening tests for blood and tissue, donor recall policies, and harm reduction strategies are in their initial stages in most countries. Many governments have put HBV and HCV drugs on their essential medicines lists and the availability of generic versions of these drugs has reduced costs. Efforts to eliminate viral hepatitis as a public health threat, together with the rapid increase in per-capita alcohol consumption in countries and the epidemic of obesity, are expected to change the spectrum of liver diseases in the Asia-Pacific region in the near future. The increasing burden of alcohol-related liver diseases can be contained through government policies to limit consumption and promote less harmful patterns of alcohol use, which are in place in some countries but need to be enforced more strictly. Steps are needed to control obesity and NAFLD, including policies to promote healthy lifestyles and regulate the food industry. Inadequate infrastructure and insufficient health-care personnel trained in liver diseases are issues that also need to be addressed in the Asia-Pacific region. The policy response of most governments to liver diseases has thus far been inadequate and poorly funded. There must be a renewed focus on prevention, early detection, timely referral, and research into the best means to introduce and improve health interventions to reduce the burden of liver diseases in the Asia-Pacific region. 168 www.thelancet.com/gastrohep Vol 5 February 2020The Lancet Gastroenterology & Hepatology Commission accounted for 108 276 (8·2%) of the total liver-related deaths in the region in 2015, compared with 929 (1·2%) of 72 437 in the USA and 4032 (0·3%) of 197 179 in Europe. Deaths in the Asia-Pacific region represented three-quarters of the global total number of deaths due to acute viral hepatitis. In 2015, the region accounted for three-quarters of the global total number of deaths related to acute HBV, almost two-thirds of those due to acute hepatitis A infection, and almost 80% of those due to acute hepatitis E infection. Of all deaths du...

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Section: Viral Hepatitis Hepatitis B D and Cmentioning

confidence: 99%

Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

Sarin

Kumar

Eslam

et al. 2020

The Lancet Gastroenterology & Hepatology

Self Cite

389

303

View full text Add to dashboard Cite

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“…This discrepancy between guideline recommendations and real-world clinical practice may be influenced by many factors, including doctors' knowledge, reimbursement policy, and patients' economic status and compliance. [22][23][24] Fortunately, this study showed the prescription of different NAs has favorably changed in the past years, with entecavir prescription increased from less than one-third to more than half. This trend may reflect the following facts: 1) evidence from clinical trial and real-world studies convincingly demonstrates the efficacy and safety of antiviral therapy, 12,25,26 2) update of evidence-based national guidelines recommends entecavir and tenofovir disoproxil fumarate as first-line therapy, 10 3) evolving national and local reimbursement policy offers more potent antiviral therapy for people who are covered by basic social medical insurance.…”

Section: Discussionmentioning

confidence: 72%

Baseline Characteristics and Treatment Patterns of the Patients Recruited to the China Registry of Hepatitis B

Shan¹,

You²,

Niu³

et al. 2019

Journal of Clinical and Translational Hepatology

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Background and Aims: Chronic hepatitis B virus (HBV) infection remains a major public health problem globally. Here, we describe the baseline characteristics and treatment profiles of HBV-infected patients recruited to the China Registry of Hepatitis B. Methods: Inclusion criteria were patients with different stages of chronic HBV infection and complete key data. Exclusion criteria were patients with hepatocellular carcinoma. The baseline clinical, laboratory and treatment profiles were analyzed. Results: Finally, 40,431 patients were included. The median age was 43 years, with 65.2% being men and 51.3% being positive for hepatitis B e antigen (HBeAg). The most common initial diagnosis was chronic hepatitis B (81.0%), followed by cirrhosis (9.3%), inactive carrier of hepatitis B surface antigen (HBsAg) (6.7%), and immune tolerant phase of hepatitis B infection (3.0%). Among the 21,228 patients who were on treatment, 88.0%, 10.0% and 2.0% received nucleos(t)ide analogues (NAs), interferon or combination of NAs and interferon, respectively. The proportion of patients who received preferred NAs (entecavir or tenofovir disoproxil fumarate) had increased from 13.5% in 2003 to 79.7% in 2016. Conclusions: We concluded that middle-aged men accounted for most of the patients with chronic hepatitis B in this cross-sectional study. About half of the patients were HBeAg-positive. NAs were the most commonly used therapy, and use of the preferred NAs had steadily increased in the past decade.

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“…Two national programs were implemented in Mainland China to control HBV infection, a universal HBV vaccination program and the reimbursement for CHB antiviral therapy in basic medical insurance . The vaccination program started in 1992 as a nationwide program offering completely free HBV vaccines and injections to all newborns .…”

Section: Discussionmentioning

confidence: 99%

“…The vaccination program started in 1992 as a nationwide program offering completely free HBV vaccines and injections to all newborns . It has successfully reduced the prevalence of HBsAg positivity from 9.75% in 1992 to 7.18% by 2006 in the general population, and then to less than 3% in the population aged <30 years old in 2014 . However, the burden of HBV‐related disease is still high as a certain number of patients had already had CHB before this vaccination program.…”

Section: Discussionmentioning

confidence: 99%

Impact of reimbursement program on liver‐related mortality in patients with chronic hepatitis B in Beijing, China

Kong

et al. 2019

J of Digest Diseases

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Objective: Since July 1, 2011 antiviral therapy for hepatitis B virus infection has been listed as a reimbursable expense for medical insurance in Beijing. This study aimed to assess the impact of this program on liver-related death for patients with chronic hepatitis B (CHB).Methods: Profiles of patients with CHB discharged between January 2008 and December 2015 were retrieved from the Beijing hospital discharge database. Liverrelated deaths in these patients occurring between January 2008 and December 2017 were retrieved by linking them to the death certification database. Liver-related mortality (number of deaths divided by the observed person-years) before and after this program was launched was calculated and compared. A Poisson regression was performed to assess the strength of association (risk ratio [RR]) between the reimbursement program and liver-related mortality.Results: Information on 35 943 discharged patients (17 114 patients with noncirrhotic and 18 829 with compensated cirrhotic CHB) was retrieved. Altogether 3 832 liver-related deaths during the 190 695 person-years were observed. After the reimbursement program was launched, liver-related mortality per 100 person-years dropped from 0.38% to 0.16% for patients with non-cirrhotic CHB, and from 4.03% to 3.39% for those with compensated cirrhosis. The program was associated with a lower risk of developing liver-related death for patients with non-cirrhotic CHB (RR 0.40, 95% confidence interval [CI] 0.30-0.52) and those with compensated cirrhosis (RR 0.84, 95% CI 0.78-0.89).Conclusion: Coverage of antiviral therapy by basic medical insurance reduced the risk of developing liver-related death for patients with non-cirrhotic and with compensated cirrhotic CHB. K E Y W O R D Schronic hepatitis B, liver-related death, insurance health reimbursement *These two authors contributed equally to this work.

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How to control highly endemic hepatitis B in Asia

Cited by 32 publications

References 35 publications

Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

Baseline Characteristics and Treatment Patterns of the Patients Recruited to the China Registry of Hepatitis B

Impact of reimbursement program on liver‐related mortality in patients with chronic hepatitis B in Beijing, China

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